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.     

T-cell variant of classical Hodgkin's lymphoma with nodal and cutaneous manifestations demonstrated by single-cell polymerase chain reaction

The atypical cells of CD30(+) cutaneous lymphoproliferative disorders (CD30CLD) are commonly of T-cell origin and frequently have a similar morphology as Hodgkin or Reed-Sternberg cells of Hodgkin's lymphoma (HL). HL is one of the tumors associated with CD30CLD. Although most studies support a B-cell derivation of the tumor cells in HL, recently a few cases of classical HL with T-cell genotype have been reported. We report a patient who presented with CD30CLD whose lymph nodes showed classical HL of mixed cellularity subtype at presentation. By single-cell PCR, the same clonal gene rearrangements of the T cell receptor-beta gene locus could be assigned to the CD30(+) and CD15(+) cells of both skin and lymph node. In a lymph node biopsy specimen taken in relapse after several courses of chemotherapy, the CD30(+) tumor cells were abundant. The T cell-derived tumor cells displayed aberrant expression of the Pax-5 gene in all specimens. A common clonal origin of both CD30CLD and HL of the lymph node in the patient presented here suggests that HL with T-cell genotype exists in association with CD30CLD as well as in sporadic cases and may share clonal origin with the skin tumor.     

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.     

An autopsy case of primary nodal plasmacytoma associated with Sjögren''s syndrome

An 81-year-old man with a 1 year history of Sjögren’s syndrome and hypergammaglobulinemic purpura was admitted because of high fever and lymphadenopathy. Primary nodal plasmacytoma was suggested from the microscopic and immunohistochemical findings of an inguinal lymph node biopsy specimen. Although chemotherapy achieved a moderate response, the patient died 2 months later from respiratory and cardiac failure. We herein, is described a rare autopsy case of primary nodal plasmacytoma associated with Sjögren’s syndrome, in which the clinical course was progressive and Epstein-Barr virus-encoded RNA 1 was positive in a small number of neoplastic plasma cells, showing some difference from previously reported cases.     

Fine-needle aspiration cytology of histiocytosis X: a case report

The cytologic features of a case of histiocytosis X diagnosed by fine-needle aspiration biopsy of a right cervical lymph node in a 15-mo-old girl are reported. Characteristic reticuloendothelial cells with abundant cytoplasm and grooved nuclei were observed. Electron microscopy of the aspiration-derived specimen revealed Birbeck granules. The cytologic pattern and electron microscopic demonstration of Birbeck granules allowed definite diagnosis of lymph node involvement by histiocytosis X, negating the need for open biopsy. The cytologic differential diagnosis and current diagnostic criteria for histiocytosis X are discussed.     

Leishmania lymphadenitis diagnosed by fine-needle aspiration biopsy

A case of Leishmania lymphadenitis which presented clinically as an isolated left laterocervical lymph node is described. Diagnosis was made by fine-needle aspiration biopsy (FNAB), as in other cases previously reported. The material obtained yielded abundant histiocytes, multinucleated giant cells, and epithelioid micro-granulomas with Leishman-Donovan pathognomic bodies in the cytoplasm of cells, together with free forms of the parasite. This paper comments on the main differential diagnoses to be considered in our region when faced with granulomatous adenitis and the role of FNAB in the identification of this parasite in endemic areas.     

Chest wall abscess: an unusual presentation of Hodgkin's lymphoma

A chest wall abscess is a very rare presentation of extranodal Hodgkin's lymphoma (HL); only one case has been reported to date. Here, we describe a case of a 38-yr-old man with HL whose initial presentation was a chest wall abscess. The diagnosis of HL was suggested by cytological examination of the purulent discharge and was confirmed subsequently by excisional biopsy of cervical lymph node.     

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.     

Extraskeletal Myxoid Chondrosarcoma with Neuroendocrine Differentiation: A Case Report with Fine-Needle Aspiration Biopsy,Histopathology, Electron Microscopy,and Cytogenetics

Although extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma, its morphological, ultrastructural, and cytogenetical features have been well investigated. The authors describe a very rare variant of EMC with neuroendocrine differentiation. A 49-year-old woman presented with an 11-cm, deep-seated, lobulated soft tissue mass in the left thigh and a lymph node metastasis in the left groin. Analysis of fine-needle aspiration biopsy (FNAB) smears and a cellblock prepared from FNAB material, as well as histological sections of the excised tumor, showed a neoplasm composed of rounded and elongated cells arranged in strands and cords in a myxoid background matrix. The nuclei were rounded and often eccentric. The immunohistochemical phenotype was S-100 protein &#109, neuron specific enolase +, and chromogranin A+. Electron microscopy showed tumor cells harboring numerous mitochondria, partial basal lamina, and unequivocal neuroendocrine granules. Molecular genetic analysis revealed a TAF15/NR4A3 fusion, a characteristic rearrangement occurring in about 25% of cytogenetically investigated EMC. A few cases of EMC with neuroendocrine differentiation have been reported. However, the only previously described case with genetic information also displayed the t(9;17) instead of the more common t(9;22), suggesting an association between type of primary chromosome abnormality and neuroendocrine differentiation.     

Extraskeletal myxoid chondrosarcoma with neuroendocrine differentiation: a case report with fine-needle aspiration biopsy, histopathology, electron microscopy, and cytogenetics

Although extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma, its morphological, ultrastructural, and cytogenetical features have been well investigated. The authors describe a very rare variant of EMC with neuroendocrine differentiation. A 49-year-old woman presented with an 11-cm, deep-seated, lobulated soft tissue mass in the left thigh and a lymph node metastasis in the left groin. Analysis of fine-needle aspiration biopsy (FNAB) smears and a cellblock prepared from FNAB material, as well as histological sections of the excised tumor, showed a neoplasm composed of rounded and elongated cells arranged in strands and cords in a myxoid background matrix. The nuclei were rounded and often eccentric. The immunohistochemical phenotype was S-100 protein -, neuron specific enolase +, and chromogranin A+. Electron microscopy showed tumor cells harboring numerous mitochondria, partial basal lamina, and unequivocal neuroendocrine granules. Molecular genetic analysis revealed a TAF15/NR4A3 fusion, a characteristic rearrangement occurring in about 25% of cytogenetically investigated EMC. A few cases of EMC with neuroendocrine differentiation have been reported. However, the only previously described case with genetic information also displayed the t(9;17) instead of the more common t(9;22), suggesting an association between type of primary chromosome abnormality and neuroendocrine differentiation.     

KSHV/HHV-8 associated Kaposi's sarcoma in lymph nodes concurrent with Epstein-Barr virus associated Hodgkin lymphoma

BACKGROUND: The unusual occurrence of a metastatic Kaposi's sarcoma (KS) in a lymph node affected by Hodgkin lymphoma (HL) was originally reported when knowledge of the specific virological features of these tumours was lacking. AIM: To re-evaluate this case by assessing whether the simultaneous presence of the two tumours was linked with common aetiopathogenetic factors. METHODS: The presence of EBV was investigated by in situ hybridisation, whereas KS associated herpesvirus (KSHV)/human herpesvirus 8 (HHV-8) was detected by immunohistochemistry. Both viruses were analysed in the case reported, in 30 lymph nodes from patients with classic HL, and in 22 skin biopsies from patients with KS. RESULTS: Consistent with the findings in the HL and KS cases analysed, in the case showing features of both HL and KS in the same lymph node, EBV was detectable only in Reed-Sternberg (RS) cells, but not in KS spindle cells, whereas KSHV/HHV-8 was detectable only in KS spindle cells, and not in RS cells. CONCLUSION: It is probable that the development of KS and HL was related to two independent aetiological cofactors-KSHV/HHV-8 and EBV, respectively-and that the occurrence of the two malignancies in the same patient was merely fortuitous.     

Fine-needle aspiration cytology of thymic basaloid carcinoma: case studies and review of the literature

We report the features in fine-needle aspiration biopsy (FNAB) of thymic basaloid carcinomas. This is a rare neoplasm, of which there are only three documented in our hospital files. To the best of our knowledge, this is the first fine-needle aspiration (FNA) report on basaloid carcinoma of the thymus. This is a tumor in which the FNA diagnosis is difficult and the differential diagnosis is broad. We describe the cytologic features encountered in the three cases, and immunohistochemical and ultrastructural findings so as to raise awareness of this entity in the differential diagnosis of thymic neoplasms on FNABs. The cases studied included three male patients, aged 73, 65, and 50, who presented with anterior mediastinal masses, with no primary tumor elsewhere. FNAB was performed on two cases, followed by thymectomy. One case, additionally, had metastasis to a cervical lymph node, and the other two were associated with thymic cysts. The diagnoses on all three cases were thymic basaloid carcinoma.     

Is core needle biopsy superior to fine‐needle aspiration biopsy in the diagnosis of papillary breast lesions?

Since the 1980s core needle biopsy (CNB) has gained remarkable popularity and in many institutions it has replaced fine-needle aspiration biopsy (FNAB). However, similar to FNAB, limitation remains in the ability of this procedure to reliably diagnose a small, but prognostically significant, number of breast lesions. These include entities such as atypical ductal hyperplasia, fibro-epithelial tumors, radial scar, papillary lesions, and lobular neoplasia. To assess the diagnostic accuracy of CNB vs. FNAB in the same breast lesions, we reviewed our cases of papillary lesions of the breast. In a retrospective study, we identified 36 cases of FNAB and 11 cases of CNB diagnosed as papillary lesions and compared the results with their corresponding surgical specimen. Interpretation ranged from papillary vs. atypical papillary lesions favoring benign vs. malignant tumors, respectively. Occasionally, definitive diagnosis of papillary carcinoma was entertained. Immunohistochemical staining with smooth muscle actin was used to evaluate the presence or absence of a myoepithelial cell layer. FNAB had benign findings in 21 lesions, atypical in 10, and malignant in five. Of the five lesions yielding malignant features, four had invasive carcinoma and one had micropapillary ductal carcinoma in situ (DCIS). Surgery revealed invasive carcinoma in three of the cases interpreted as atypical papillary lesions and invasive cancer and micropapillary DCIS in three of the cases diagnosed as benign lesions. Similar results were obtained with CNB. DCIS was found in one out of six of the cases diagnosed as papilloma. Out of the four cases that were interpreted as atypical papillary lesion, surgery revealed invasive carcinoma in one case and one case had micropapillary DCIS. Diagnosis of malignancy was confirmed by histology in one case interpreted as papillary carcinoma by CNB. This study suggested that both FNAB and CNB share similar diagnostic challenges and a follow-up surgical excision is indicated when diagnosis of a papillary lesion is entertained by both procedures.     

Primary diagnosis of malignant mesothelioma by fine-needle aspiration of a supraclavicular lymph node

Malignant mesothelioma is a rare neoplasm with poor prognosis. The pleural form is defined as a malignant tumor of mesothelial cells with a diffuse growth pattern involving the visceral and parietal surfaces of the pleura. To our knowledge, there have only been two reported cases in the literature where fine-needle aspiration (FNA) of a lymph node was the primary mode of diagnosis of malignant mesothelioma. We describe a 40-yr-old male in whom the primary diagnosis of malignant mesothelioma was made by FNA of a supraclavicular lymph node. The mesothelial origin of the tumor was confirmed with immunohistochemical studies. A pleural biopsy immediately preceding the FNA was interpreted as chronic inflammation. Most patients with clinically documented lymph node metastases of malignant mesothelioma have had a previously established diagnosis of mesothelioma. Our case demonstrates that FNA can be a simple and invaluable method of diagnosis in those unusual cases where diagnosis of malignant mesothelioma has not already been made before lymphadenopathy.     

Fine-needle aspiration biopsy of monophasic variant of spindle epithelial tumor with thymus-like differentiation of the thyroid: report of one case and review of the literature

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare biphasic tumor of the thyroid with approximately 20 well-documented cases reported in the English literature. Although a monophasic variant of SETTLE is conceivable, the majority of the reported cases were truly biphasic tumors. A minimal amount of epithelial component was present in the reported cases of so-called spindle-cell predominant SETTLE. Here, we report an apparently monophasic case of SETTLE in a 16-yr-old girl, in which no epithelial cells were identified in either fine-needle aspiration biopsy (FNAB) or the subsequent hemithyroidectomy specimen. The FNAB smears were moderately cellular and composed of single and loosely grouped spindle cells with homogenous metachromatic material, which could be mistaken as amyloid, erroneously suggesting medullary thyroid carcinoma. The compact nodules of uniform spindle cells in histology sections raised the possibility of monophasic synovial sarcoma. The spindle cells stained positive for both cytokeratin and vimentin, but were negative for thyroglobulin and calcitonin as well as neuroendocrine markers, confirming the diagnosis of SETTLE.     

Differentiating between endocervical glandular neoplasia and high grade squamous intraepithelial lesions in endocervical crypts: Cytological features in ThinPrep and SurePath cervical cytology samples

A recent audit at our institution revealed a higher number of cases diagnosed as endocervical glandular neoplasia on ThinPrep (TP) cervical cytology samples (9 cases) as opposed to SurePath (SP) (1 case), which on histology showed only high‐grade cervical intraepithelial neoplasia (CIN) with endocervical crypt involvement (CI). We attempted to ascertain the reasons for this finding by reviewing the available slides of these cases, as well as slides of cases diagnosed as glandular neoplasia on cytology and histology; cases diagnosed as high‐grade squamous intraepithelial lesions (HSIL) on cytology which had CIN with CI on histology and cases with mixed glandular and squamous abnormalities diagnosed both cytologically and histologically. Single neoplastic glandular cells and short pseudostratified strips were more prevalent in SP than TP with the cell clusters in glandular neoplasia 3–4 cells thick, in contrast to the dense crowded centre of cell groups in HSIL with CI. The cells at the periphery of groups can be misleading. Cases with HSIL and glandular neoplasia have a combination of the features of each entity in isolation. The diagnosis of glandular neoplasia remains challenging and conversion from conventional to liquid based cervical cytology requires a period of learning and adaptation, which can be facilitated by local audit and review of the cytology slides in cases with a cytology–histology mismatch. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Nodular sclerosing classical Hodgkin lymphoma masquerading as acute suppurative‐necrotizing lymphadenitis

The diagnosis of nodular sclerosing classical Hodgkin lymphoma (NSCHL) by fine‐needle aspiration (FNA) biopsy has historically been a diagnostic challenge due to the usual paucicellularity of the specimen. This case report, and other previously published reports, suggests that there is another facet to the potentially challenging diagnosis of this particular variant of Hodgkin lymphoma (HL): the presence of suppurative‐necrotizing changes mimicking an infectious etiology. The patient presented here underwent FNA biopsy of an acutely enlarged supraclavicular lymph node and cytologic smears showed marked acute inflammation in a background of necrosis. A diagnosis of infectious suppurative lymphadenitis was made at that time. After a negative infectious work‐up with infectious disease consultation, an excisional biopsy was performed and the patient was definitively diagnosed with NSCHL. The presence of neoplastic Hodgkin and Reed‐Sternberg cells in the purulent exudate was minimal and only appropriately identified after retrospective review. This particular subtype of classical HL represents a potential pitfall in FNA biopsy cytology. Consequently, the cytopathologist and surgeon should always consider this entity in the differential diagnosis of a suppurative, lymphadenitis‐like aspirate, and pursue repeat FNA or an excisional biopsy if there is any clinical index of suspicion. Diagn. Cytopathol. 2014;42:238–241. © 2011 Wiley Periodicals, Inc.     

Extramedullary multiple myeloma involving the liver and periportal lymph node,diagnosed by EUS‐FNA in a patient with cirrhosis

Extramedullary multiple myeloma (EMM) involving the liver as a focal space‐occupying lesion is very rare, especially in the patients with cirrhosis. Here, we report a case of EMM in the liver and periportal lymph node, diagnosed by endoscopic ultrasound guided‐fine‐needle aspiration (EUS‐FNA). A 57‐year‐old male patient, with history of cirrhosis, presented with abdominal pain and pancytopenia. The abdominal magnetic resonance imaging (MRI) demonstrated a 6.5 cm left hepatic mass with a 1.1 cm malignant‐appearing periportal lymph node and diffuse osseous lesions. The cytology specimens from the hepatic mass and the periportal lymph node were obtained through EUS‐FNA without rapid on‐site evaluation (ROSE). The thin‐layer preparations (ThinPrep) showed abundant plasmacytoid cells, which were confirmed to be Kappa‐restricted neoplastic plasma cells by the cell block preparations. Later, his serum level of Kappa light chain was found significantly elevated by flow cytometry, which was identified as monoclonal IgA Kappa light chain by serum protein electrophoresis (SPEP) with immunofixation. The patient was diagnosed as IgA multiple myeloma with extramedullary involvement of the liver and periportal lymph node. This is the first case showing the ThinPrep cytomorphologic features of EMM in the liver and periportal lymph node. This case highlights the importance of distinguishing plasma cells from being hepatocytes and lymphocytes on the ThinPrep and also emphasizes the utility of the cell block in the diagnosis of plasma cell neoplasm.     

Interdigitating Reticulum Cell Sarcoma with Unusual Features

A case of interdigitating reticulum cell sarcoma is reported in a cervical lymph node of a 67-year-old man who had a previously diagnosed nodular lymphocytic lymphoma in the same anatomic location. Ultrastructurally, the neoplastic cells contained cylindrical confronting cisternae, and associated benign lymphocytes had tubuloreticular structures in their cytoplasm. The patient was treated with combination chemotherapy-radiation therapy and is alive and well with no evidence of disease approximately 2 years after completing therapy. The clinical and pathologic features of previously reported cases of interdigitating reticulum cell sarcomas are compared to those of the reported case.     

Diagnostic utility of immunohistochemical staining for p63, a sensitive marker of prostatic basal cells.

Diagnostically reliable identification of prostatic basal cells has depended on staining for high molecular weight cytokeratin. The diagnosis of malignancy is often based on the absence of basal cells. False-negative staining is occasionally observed. Thus, a second method of identifying basal cells might prove useful. Selective expression of p63, a homologue of p53, has been demonstrated in prostatic basal cells. We investigated the diagnostic utility of p63 staining in 70 consecutive specimens for which the differential diagnosis included prostatic adenocarcinoma: 68 needle biopsies and 2 transurethral resection blocks. High molecular weight cytokeratin staining was the gold standard when material was available. A total of 61 specimens were diagnosed as carcinoma, 4 as atrophy, 2 as high-grade prostatic intraepithelial neoplasia, 2 as unclassified collections of benign glands, and 1 as carcinoma versus high-grade prostatic intraepithelial neoplasia. Sections mounted on charged slides were used for p63 staining for 14 specimens. Sections previously hematoxylin and eosin stained on uncharged slides were used for 56 specimens. In every case in which there was successful p63 staining (55 specimens), basal cells in benign lesions were properly marked and other cell types were not stained. Uninformative staining in the remaining 15 specimens was due to failure of tissue adherence in 14 specimens in which sections were on uncharged slides and, in 1 specimen, to poor positive internal control staining of benign glands. Thus, p63 staining was informative in 55 of 56 specimens (98%) for which there was material for examination. No case with satisfactory p63 and high molecular weight staining showed disagreement between the two stains. An additional group of 21 transurethral resection specimens was stained (p63 and high molecular weight cytokeratin). There was less false-negative staining for p63 compared with the case of high molecular weight cytokeratin. No false-positive staining was seen. We conclude that p63 staining is at least as sensitive and specific for the identification of basal cells in diagnostic prostate specimens as is high molecular weight cytokeratin staining.