Spontaneous Cutaneous Endometriosis in the Mons Pubis Region

Most cutaneous endometriosis develops at the site of an abdominal surgical scar. Spontaneous cutaneous endometriosis is extremely rare. We report a case of spontaneous cutaneous endometriosis in the mons pubis region. A 41‐year‐old woman presented with a mass in the right mons pubis, causing cyclic pain associated with menses. Fine‐needle aspiration (FNA) biopsy was performed. The smears contained three cellular components: honeycombed sheets of glandular epithelial cells, fragments of ovoid‐to‐spindle shaped stromal cells, and background inflammatory cells, including hemosiderin‐laden macrophages, histiocytes, and neutrophils. Biphasic clusters of glandular epithelial cells and stromal cells were identified. FNA cytology is a safe and useful adjunctive tool for diagnosing cutaneous endometriosis. Diagn. Cytopathol. 2014;42:615–618. © 2013 Wiley Periodicals, Inc.     

Fine‐needle aspiration cytology of endometriosis

Endometriosis commonly involves the pelvis, but may also present as a palpable mass in extrapelvic sites, such as the abdominal wall or inguinal region, where it can be evaluated by fine needle aspiration (FNA). In this report, we illustrate the findings seen in seven cases of endometriosis diagnosed by FNA in patients with a chief complaint of pain associated with an abdominal wall or pelvic mass, occurring in a setting of prior pelvic surgery. The most common previous surgery was Cesarean section (n = 6), followed by hysterectomy (n = 2), and hernia repair (n = 1). In all cases, cytologic examination revealed a glandular component composed largely of orderly fragments of cohesive epithelial cells, a spindle cell stromal component presenting either as loosely organized tissue fragments or single cells, and rare hemosiderin‐laden macrophages. Four cases showed focal cytologic atypia in the glandular component with extreme nuclear atypia identified in two of these cases. Atypical features included nuclear crowding and disorganization, nuclear enlargement, hyperchromasia with irregular chromatin distribution and anisonucleosis, raising the possibility of a coexistent malignancy and recommendation for excision. Although malignancy was not identified in follow‐up surgical excision specimens, the wide range of cytomorphologic changes that can be seen in FNA specimens of endometriosis should be recognized. Diagn. Cytopathol. 2017;45:359–363. © 2016 Wiley Periodicals, Inc.     

Fine‐needle aspiration biopsy of endometriosis of the abdominal wall: A potential diagnostic pitfall

Endometriosis is a relatively common disease in women, usually of reproductive age. In rare occasions, endometriosis may occur in unusual body sites, including extragonadal, extra‐pelvic sites, or in the skin. We report a case of endometriosis of the abdominal wall diagnosed by fine‐needle aspiration biopsy (FNAB). The patient was a 41‐year‐old woman with a clinical impression of “desmoid” tumor of the abdominal wall. FNAB showed groups of epithelial cells with mild nuclear atypia and rare mitoses. A few small clusters of slightly atypical spindle cells were also seen. The initial screening impression was adenocarcinoma due to the atypical cytological features. However, after review with the pathologist, the FNAB was signed out as “endometriosis.” Subsequent local excisional biopsy confirmed the diagnosis of endometriosis. In conclusion, endometriosis may present diagnostic challenges in FNAB and this possibility should be considered in differential diagnosis. A clinical cytopathological correlation is necessary to avoid a misdiagnosed as an adenocarcinoma. Diagn. Cytopathol. 2011. © 2010 Wiley‐Liss, Inc.     

Cystosarcoma phyllodes of the breast: a cytologic and clinicopathologic study of 23 cases

Twenty-three cases of cystosarcoma phyllodes of the breast were studied clinically and by fine-needle aspiration (FNA) cytology as well as by tumor histology. The median patient age was 52 yr. The total actuarial survival at 5 yr was 90%, and the recurrence-free survival was 70%. A combination of stromal elements (tissue fragments and/or single spindle cells) and epithelial tissue was required to make the diagnosis on smear material. In FNA smears, stromal elements were absent in two cases, and ductal elements were not seen in three. Thus, the dimorphic pattern essential to this diagnosis was not present in five (22%) cases. An evaluation of tumor factors reported to be of prognostic significance was performed on histologic sections of resected tumors. Comparison of these data with FNA results indicates that little prognostic information can be obtained from FNA alone in most cases.     

Endometriosis of sigmoid colon mimicking malignant tumor diagnosed by intraoperative imprint cytology

A case of endometriosis of the sigmoid colon on imprint cytology from an intraoperative biopsy is discussed. Cytologic specimens showed sheets or tubular epithelial clusters and stromal fragments. The epithelial cell nuclei were small and round to ovoid with finely granular chromatin and inconspicuous nucleoli. The background showed a few scattered spindle-type stromal cells without pigment-laden histiocytes. A definitive diagnosis of endometriosis can be based on cytology, provided that the cytologic findings are interpreted in the appropriate clinical context.     

Hepatic endometriosis diagnosed by liquid‐based cytology: A Case Report

A 44‐year‐old woman presented to Emergency Department with sudden onset of severe upper abdominal pain. T2‐weighted MRI image showed a large cystic mass with a thickened wall measuring 9.5 × 9.1 × 11.2 cm in the right hepatic lobe. It was radiologically interpreted as a cystic mass with differential diagnosis including echinococcal cyst, biliary cystadenoma, and malignant neoplasm. The cystic mass was intraoperatively aspirated and a liquid‐based cytology preparation (ThinPrep) and a cell block were made. The ThinPrep slides showed three dimensional clusters of epithelioid cells with scant delicate cytoplasm and tissue fragments composed of small stromal cells with round to oval shaped nuclei and a small amount of dense cytoplasm lined by the cuboidal epithelial cells. Occasional ciliated cells and abundant hemosiderin laden macrophages were also present. The cell block showed many tissue fragments containing glands and stroma with associated hemorrhage and hemosiderin laden macrophages, typical of endometrial tissue. Although it is uncommon, hepatic endometriosis should be considered in the differential diagnosis of cystic liver mass in women, especially those with a history of endometriosis or obstetric/gynecologic surgery. Diagn. Cytopathol. 2014;42:441–444. © 2013 Wiley Periodicals, Inc.     

The role of peritoneal washings in the diagnosis of endometriosis

Endometriosis, the presence of endometrial tissue outside the uterine corpus, is a common finding in reproductive age women. It is classically diagnosed based on the presence of at least two of the following elements: endometrial glands, endometrial stroma, and hemosiderin‐laden macrophages (HLMs). Although a common finding in surgical pathology specimens at the time of gynecologic surgery, there is little literature on the role of pelvic washings in diagnosing endometriosis. Our study aimed to examine the characteristics of endometriosis in pelvic washings at the time of gynecologic surgery. We report nine cases of endometriosis diagnosed on pelvic washing. Two had a reported history of endometriosis. Four had endometriosis on the concurrent surgical pathology specimen. Liquid‐based cytology was diagnostic of endometriosis in seven patients, including five with glandular cells and HLMs and two with glandular cells, HLMs, and endometrial stromal cells. Cell block was diagnostic of endometriosis in eight patients, including four cases with intact fragments of endometrial glands and stroma. Three cases showed glandular cells and HLMs, while one showed separate fragments of glandular cells and stromal cells. Pelvic washings increased the diagnostic yield for endometriosis at the time of gynecologic surgery, as only four out of nine cases had endometriosis diagnosed on surgical pathology. Cell block in particular aids in the diagnosis, since intact glandular and stromal fragments frequently can be identified.     

Fine‐needle aspiration cytology of scar endometriosis: Study of seven cases and literature review

Endometriosis is defined as the presence of endometrial‐like glands and stroma outside the uterine endometrial lining. Endometrial tissue has also been identified in numerous surgical or procedure scars, including cesarean section and laparoscopic trocar tract. A prospective study was conducted at Maternidade‐Escola Assis Chateaubriand, Faculty of Medicine, Federal University of Ceara, Brazil in seven patients with abdominal wall mass pathologically proven as scar endometriosis from January 2004 to December 2008. All cases were submitted to fine‐needle aspiration cytology (FNAC). Age ranged from 21 to 42 years old (mean: 30) with parity ranging from 0 to 3 (mean: 1.4). The preceding history of pelvic procedures was miomectomy (1 of 7), cesarean section (3 of 7), and diagnostic laparoscopy (3 of 7). The complaints occurred about 18 months after the surgical proceeding. The FNAC findings were endometrial‐like epithelial cells (6 of 7) and stromal cells (6 of 7); decidualization occurred in 2 of 7 cases. Hemosiderin‐laden macrophages were present in all cases. FNAC is a fast and accurate method to make the diagnosis before the surgery, avoiding errors in the approach of the abdominal wall endometriosis' scars. Diagn. Cytopathol. 2011;39:18–21. © 2010 Wiley‐Liss, Inc.     

Pleomorphic adenoma with bizarre myoepithelial cells: A diagnostic challenge on cytologic smear

The diagnosis on fine needle aspiration of salivary gland tumors with a myoepithelial component is challenging because myoepithelial cells can have a wide cytomorphologic spectrum. The authors report a case of a pleomorphic adenoma of the parotid gland that expands the spectrum of appearances that myoepithelial cells can show with this tumor. A 55‐year‐old female was found to have a right parotid gland mass. FNA showed hypercellularity, with loosely cohesive fragments of spindle‐shaped myoepithelial cells admixed with small nests of epithelial cells. Interspersed may occasional bizarre cells possessing severely pleomorphic nuclei with hyperchromasia. The cytologic diagnosis was “suspicious for carcinoma ex pleomorphic adenoma.” A total parotidectomy was performed with complete resection of the tumor that was confirmed to be a pleomorphic adenoma. The pleomorphic cells noted on FNA were scattered throughout the tumor, and were positive by immunostaining for keratin, S‐100 protein and p63, identifying them as myoepithelial cells. These cells did not show mitotic activity and were negative for Ki67. The pleomorphic adenoma showed extensive degenerative changes including central cyst formation, stromal hyalinization and hemosiderin deposition. On the basis of the combined light microscopic and immunohistochemical findings, there was no evidence to support a malignant change in the pleomorphic adenoma. It was concluded the pleomorphic myoepithelial cells were a degenerative change, reminiscent of what is seen in “ancient” schwannoma and some uterine leiomyomata. Our case expands the spectrum of appearances that can be seen in myoepithelial cells in the salivary gland.     

Hyalinizing clear-cell carcinoma of salivary glands in fine-needle aspiration

Hyalinizing clear-cell carcinoma (HCCC) is a recently described distinctive salivary gland neoplasm. Because of its cytoplasmic clearing and the bland nuclear features, HCCC resembles other tumors. The authors describe the cytomorphologic features of four cases of HCCC in fine-needle aspirates (FNA) and discuss the differential diagnosis. Fine-needle aspirates from 4 patients with primary HCCC of minor salivary glands were reviewed. Smears were stained with Diff-Quik and Papanicolaou stains. The cytologic features of the epithelial and the stromal components were analyzed. Cell blocks were prepared, and findings were correlated with prior or subsequent surgical specimens in each case. The smears contained numerous cohesive small and large epithelial cell groups and sheets which had sharp outlines and showed focal nuclear overlapping. The cells had uniform round to ovoid nuclei, granular chromatin, and small nucleoli. The abundant, well-defined cytoplasm was clear in many cells but denser in others. No myoepithelial cells or hyaline globules were identified. HCCC seems to have characteristic cytomorphologic findings on FNA smears. Because these cytologic features are not specific, and overlap with those of a number of salivary gland neoplasms that contain clear cells, a high level of suspicion, clinico-pathologic correlation, and examination of cell blocks are necessary to suggest the diagnosis. A diagnosis of HCCC by FNA was suspected in 3 of the 4 cases reported here.     

Fine-needle aspiration cytology of phyllodes tumors

Breast lesions with a significant spindle cell or mesenchymal component are not commonly encountered in fine-needle aspiration (FNA) cytologic material and include a heterologous variety of benign and malignant conditions, with phyllodes tumors (PTs) being the foremost differential diagnostic consideration. This study comprises 28 tumors diagnosed histologically as PT in which FNAC material was available for review. Histological sections and cytological smears from these cases were retrieved and subjected to detailed morphological review. Cytological parameters assessed included ratio of stroma to epithelium, pattern characteristics and cytological characteristics of the stromal, and epithelial components and the background cells. Large and hypercellular stroma fragments, dissociated spindle and plump stromal cells, often accompanied by large, folded sheets of epithelium were cytological features that characterized PT. Smears from malignant PT showed predominantly or solely mesenchymal components. FNAC was a highly reliable procedure for the diagnosis of PT, giving an accuracy rate of 92.8%.     

Thymoma with pseudosarcomatous stroma.

Thymoma with psuedosarcomatous stroma is a recently described, rare variant of thymomas that are characterized by having a biphasic histologic pattern which consists of both an epithelial and a spindle cell stromal component. So far only 11 cases having similar histologic findings have been reported worldwide. At this time we report a case of this rare variant of thymoma which occurred in a 53-year-old Korean man. This previously healthy patient presented with coughing and an anterior mediastinal mass was then detected radiographically. Mediastinal exploration revealed a 9 x 8 x 8 cm-sized well- encapsulated, ovoid, cystic mass. Histological examination showed a biphasic neoplasm composed of anastomosing nests of epithelial cells and somewhat cellular stromal spindle cells that had advanced degenerative changes. Immunohistochemical staining using the antibodies for cytokeratins, EMA, e-cadherin, and p75NGFR showed a strong expression of these markers in the epithelial component but no expression in the spindle stromal cells. The epithelial tumor cells showed no reactivity to CD5 and L26 and a high proportion of the infiltrated lymphocytes were the cortical type that expressed CD99 and terminal deoxynucleotidyl transferase. Ultrastructural examinations revealed tonofilaments in the spindle cells. Follow up has been done for 5 years after the surgical excision and the patient has been free of disease during that period. Similar to previous reports, this patient had a benign clinical course that was unassociated with myasthenia gravis which appears to be a characteristic of this histologic variant of thymoma. However, our case also showed advanced degenerative features and we could demonstrate ultrastructural evidence of epithelial differentiation in the stromal spindle cells that were not mentioned in the previously reported cases. Based on the results of our studies, we suggest this entity is a distinct type of organotypic thymoma that shows cortical differentiation and abundant cellular stroma.     

胃间质瘤的病理特征和临床诊治分析

目的探讨胃间质瘤(GST)的临床表现、病理特征及临床诊治措施。方法对本院1996年6月-2006年6月10年间收治的经手术和病理组织学确诊的53例GST患者临床资料进行回顾性分析。结果本组病例首发症状表现为上消化道出血28例,其中包括腹部包块1例;腹痛或腹胀25例,其中包括腹部包块3例。胃镜检查发现37例,其中活检明确诊断11例,上消化道钡餐造影检查发现25例,CT检查发现33例,B超检查发现38例。本组患者均行切除,手术切除不全(1例)、术后复发(4例)或远处转移(1例)的患者应用甲磺酸依马替尼(Gleevec)辅助治疗。病理检查:良性GST患者16例(30.2%),交界性GST患者8例(15.1%),恶性29例(53.9%);肿瘤主要由梭形细胞构成19例、上皮样细胞构成11例、梭形细胞与上皮样细胞共同构成23例,恶性患者3例发现瘤巨细胞。随访1~6年,8例患者死亡,16例手术后复发,其中5例服用Gleevec部分缓解,余29例患者健在。结论GST临床表现以消化道慢性出血、上腹部不适等为主。内镜及消化道钡餐造影检查是诊断GST的主要方法。恶性多见,肿瘤主要由梭形细胞、上皮样细胞或梭形细胞与上皮样细胞共同构成。手术切除是GST的主要治疗方式,GLeevec辅助治疗不能切除或术后复发的GST具有较好的临床疗效。     

Morphologic features of endometriosis in various types of cytologic specimens

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. This study evaluates the cytomorphologic features of endometriosis in various cytologic specimen types [fine‐needle aspiration (FNA), effusion cytology (EF), touch imprint (ToP), and cervical smear (PAP)], and assesses the key elements helpful in recognizing this lesion. A total of 18 cases (8 FNA, 4 EF, 5 ToP, and 1 PAP) of cytologically diagnosed and histologically/clinically confirmed endometriosis diagnosed between 1988 and 2006 comprises the material for this study. The morphologic features evaluated of the three components included: cellularity, presence of sheets of glandular cells, three‐dimensional (3D) glandular clusters, tubular structures, single cells, syncytial groups of stromal cells, stromal cells entrapped within basement membrane (BM)‐like material, cytologic atypia, presence of mitotic figures, and hemosiderin‐laden histiocytes. Endometrial glands, stroma, and hemosiderin‐laden histiocytes were all identified in 14/18 (77.8%) cases. FNA specimens were more cellular than that of both EF and ToP specimens. Tubular structures, 3D glandular clusters, stromal cells entrapped in BM and syncytial stromal groups were more common in FNAs, and ToPs compared with the EFs. The ratio of the endometrial glandular and stromal cells was similar in all specimen types. Atypia and mitotic figures were rarely encountered. Diagnosis of endometriosis could be made independently on either smears/ThinPrep^? slides or on cell blocks in all cases where these preparations were available. On follow up, none of the patients developed malignancy. Endometriosis can be reliably and safely diagnosed in various cytologic materials. Cytologic atypia is uncommon. Components of endometriosis could show minor morphologic alterations in different specimen types. Diagn. Cytopathol. 2013;41:936–942. © 2013 Wiley Periodicals, Inc.     

胃间质瘤的病理特征和临床诊治分析

目的 探讨胃间质瘤(GST)的临床表现、病理特征及临床诊治措施.方法 对本院1996年6月-2006年6月10年问收治的经手术和病理组织学确诊的53例GST患者临床资料进行回顾性分析.结果 本组病例首发症状表现为上消化道出血28例,其中包括腹部包块1例;腹痛或腹胀25例,其中包括腹部包块3例.胃镜检查发现37例,其中活检明确诊断11例,上消化道钡餐造影检查发现25例,CT检查发现33例,B超检查发现38例.本组患者均行切除,手术切除不全(1例)、术后复发(4例)或远处转移(1例)的患者应用甲磺酸依马替尼(Gleevec)辅助治疗.病理检查:良性GST患者16例(30.2%),交界性GST患者8例(15.1%),恶性29例(53.9%);肿瘤主要由梭形细胞构成19例、上皮样细胞构成11例、梭形细胞与上皮样细胞共同构成23例,恶性患者3例发现瘤巨细胞.随访1～6年,8例患者死亡,16例手术后复发,其中5例服用Gleevec部分缓解,余29例患者健在.结论 GST临床表现以消化道慢性出血、上腹部不适等为主.内镜及消化道钡餐造影检查是诊断GST的主要方法.恶性多见,肿瘤主要由梭形细胞、上皮样细胞或梭形细胞与上皮样细胞共同构成.手术切除是GST的主要治疗方式,GLeevec辅助治疗不能切除或术后复发的GST具有较好的临床疗效.     

Diagnosis of recurrent uterine carcinosarcoma by fine-needle aspiration cytology: report of a case

Uterine carcinosarcomas are uncommon, aggressive neoplasms usually afflicting postmenopausal women. Histologically, they are characterized by the presence of both malignant epithelial and stromal cells. The latter may be either homologous or heterologous in nature. The cytologic diagnosis of carcinosarcoma via fine-needle aspiration (FNA) was previously described for primary tumors arising in the parotid gland, breast, lung, and ovary. Although the diagnosis of uterine carcinosarcoma via cervicovaginal, endometrial, and peritoneal fluid cytology has been described, the FNA cytology diagnosis of recurrent uterine carcinosarcoma has only been rarely described. We present a case of recurrent uterine carcinosarcoma in a 59-yr-old woman, diagnosed by ultrasound-guided FNA cytology. Cytologic smears showed a biphasic neoplasm consisting of both malignant columnar epithelial and spindle cells, in a background of tumor diathesis. This case illustrates the diagnostic utility of aspiration cytology in the investigation of recurrent carcinosarcoma in clinically suspicious lesions arising postsurgery.     

Diagnosis of endometriosis by fine-needle aspiration cytology.

Endometriosis is a fairly common disease found in a variety of extrauterine locations. It primarily affects reproductive age women and has symptoms varying from occult to more specific complaints. Occasionally the lesions produce solid nodules and/or cysts that are clinically palpable and easily evaluated by fine needle aspiration (FNA). We describe three cases of endometriosis diagnosed by FNA. The patients ranged in age from 32 to 38 and reported cyclic symptoms of pain, bleeding, or change in mass size. Two patients presented with subcutaneous masses (one along the upper pubic ramus, the other in the lower abdomen) and had ultrasonically guided FNA. The third patient had a vaginal cuff mass sampled by transvaginal FNA. All cytologic smears contained characteristic sheets of epithelial cells and fragments of loosely arranged spindled stroma. One case also showed mild epithelial atypia and plump stromal cells. Hemosiderin-laden macrophages were found in only one case. The cytologic diagnoses were confirmed by tissue in all patients. Endometriotic nodules must be evaluated for possible malignant transformation and differentiated from other benign and malignant masses, especially when clinical symptoms are vague. FNA offers a safe and effective tool for identification of endometriosis and obviates the need for diagnostic surgical procedures in some patients.     

Fine needle aspiration of secondary synovial sarcoma of the thyroid gland

Synovial sarcomas (SS) of the head and neck region are extremely rare and arise in only 5% of cases. We present a case of secondary SS of the thyroid originally diagnosed as medullary carcinoma on fine needle aspiration (FNA). A 41‐year‐old man presented with several weeks of dysphonia and a left thyroid mass. FNA of the thyroid nodule showed a cellular smear composed of loosely cohesive oval to spindle‐shaped cells with irregular nuclear borders, finely granular chromatin, and inconspicuous nucleoli. The patient was diagnosed with medullary carcinoma and underwent a total thyroidectomy. Intro‐operatively, the mass was found to arise from the tracheoesophageal groove with spread to the left thyroid. Microscopic examination of the thyroid tumor revealed a dense spindle cell proliferation with abundant mitoses, scant cords and nests of epithelial cells and foci of necrosis. The spindle cells were positive for bcl2 and vimentin and the epithelial cells were positive for cytokeratin 8/18 and epithelial membrane antigen (EMA). Both spindle and epithelial cells were negative for thyroglobulin, calcitonin, synaptophysin and chromogranin. Fluorescence in situ hybridization (FISH) demonstrated translocation (X;18)(p11;q11), confirming the diagnosis of SS. The patient underwent a total laryngopharyngoesophagectomy with subsequent adjuvant therapy and is currently disease free. Only 6 cases of histologically confirmed primary SS of the thyroid have been reported. To the best of our knowledge, this is the first case of FISH‐confirmed secondary SS of the thyroid and also the first case of SS arising from the tracheoesophageal groove. Diagn. Cytopathol. 2015;43:928–932. © 2015 Wiley Periodicals, Inc.     

Fine‐needle aspiration of soft tissue myoepithelioma

Soft tissue myoepithelioma is a rare neoplasm composed of myoepithelial cells. We describe the cytologic features of a soft tissue myoepithelioma arising in the right lower chest wall in a 65‐year‐old woman. The fine‐needle aspiration (FNA) smears showed round to oval, spindle, epithelioid, and plasmacytoid cells in the myxoid background. The nuclei were uniform, round to ovoid, with finely distributed chromatin and eosinophilic or pale cytoplasm, and resembled lobular carcinoma of breast. Ultrasound guided core biopsy showed the tumor cells had bland cytologic features, arranged in small cords, nests, and dissociated single cells, with no glandular differentiation or breast tissue seen. The tumor cells demonstrated immunoreactivity for cytokeratin (AE1/AE3) and glial fibrillary acidic protein, but were negative for estrogen receptor. Fluorescence in situ hybridization demonstrated the EWSR1 rearrangement, confirming the diagnosis of myoepithelioma. Diagn. Cytopathol. 2016;44:152–155. © 2015 Wiley Periodicals, Inc.