Aspiration cytology of neuroendocrine tumors below the diaphragm

In a series of 630 transabdominal fine-needle aspirates, 24 neuroendocrine tumors (NETs) presenting below the diaphragm were encountered. Of these, 10 were classic small-cell undifferentiated carcinomas (SCUCs). Recognition of SCUC in abdominal aspirates has major directive value, pointing to bronchogenic origin, possibly unsuspected, in most cases (eight of 10 in this series). The other 14 NETs were 10 pancreatic islet-cell tumors and four intestinal carcinoids, both diagnosed more frequently in metastatic than in primary sites (10 of 14 in the liver in this series). The cytologic presentation of these non-SCUC neoplasms has received little literature attention, and it is described and illustrated here, with discussion of cytologic pitfalls and differential diagnoses. Diagnostic specificity was 100%, and sensitivity was also 100%, exclusive of two sampling errors. The purpose of this article is to establish a broader view of the range of morphological features of the extended neuroendocrine group of tumors in aspiration cytology.     

Aspiration cytology of palpable lesions of the scrotal content

To date, we have studied 89 palpable lesions of the scrotum, testicle, and epididymis using fine-needle aspiration cytology (FNAC). Cystic lesions (48.3%) and inflammatory pathology (25.8%) were the most frequent findings. Tumors accounted for 11.2% of results, with a slight predominance of the malignant varieties. In this article, we describe the cytopathology of the main entities and discuss the principal problems of differential diagnosis, especially among inflammatory processes, seminomas, and embryonal carcinomas. The cytopathological pattern of the neoplasias is highly characteristic, and this permits their diagnosis with great precision. FNAC is essentially nontraumatic and easy to carry out, but it requires considerable practice in its execution and in the interpretation of the aspirates. We believe FNAC to be the technique of choice for the study of the pathology of the scrotal content, and we think that it should be employed on the patient's very first visit. The main advantage of FNAC is avoiding delays in diagnosis.     

Male breast lesions: gynecomastia and its distinction from carcinoma by aspiration biopsy cytology

Gynecomastia is a benign proliferative lesion of the male breast. It may present as a diffuse bilateral process or a unilateral, discrete mass, clinically suggestive of carcinoma. We examined the aspiration biopsy cytology of 50 cases of gynecomastia to define the cytologic criteria and to distinguish it from carcinoma. The parameters of cellularity, architecture, single columnar cells, naked nuclei, nuclear and cell size, nuclear and cytoplasmic characteristics, and extraneous cells were accessed. Diagnostic confusion with carcinoma may occur because of cellularity with loose groups and single cells; however, the mixed cell population, composed of cohesive sheets or groups of bland cells, bipolar naked nuclei, and single tall columnar cells, delineates gynecomastia from carcinoma of the male breast.     

Aspiration cytology in Sweden: The Karolinska Group

The method of aspiration biopsy cytology began to receive international attention after publications, innovations, and courses originating at the Karalinska Hospital in Sweden. Sixteen Franzen, Josef Zajieek, Pier Esposti, and Torsten Lowhagen were prime movers of this clinical and scientific development. The history of their arrival at the Karolinska and their seminal contributions is reviewed.     

Aspiration biopsy cytology of secretory carcinoma of the breast

Aspirate from a secretory carcinoma of the breast showed malignant epithelial cells present singly or in large sheets with strong cellular cohesiveness. Tumor cells displayed ill-defined, granular, or vacuolated cytoplasm. Intracytoplasmic globular material was periodic acid-Schiff positive and resistant to prior diastase digestion. The cytologic differential diagnosis with other breast cancers is briefly discussed.     

Aspiration cytology of clear-cell lesions of the parotid gland: Morphologic features and differential diagnosis

Clear-cell lesions of the parotid gland are uncommon but when studied by fine-needle aspiration may result in a clinically important but cytologically difficult differential diagnosis. Clear-cell lesions involving the parotid include acinic cell neoplasm, clear cell oncocytoma, mucoepidermoid carcinoma, primary clear-cell carcinoma, epithelial-myoepithelial carcinoma, and metastatic renal cell carcinoma. Accurate diagnosis is achieved by assessment of nuclear features, other cell populations present, and clinical data including radiographic studies.     

Aspiration biopsy cytology of malignant papillary breast neoplasms.

Papillary carcinoma of the breast is a rare neoplasm characterized by a low grade of malignancy. From the files of the Department of Histopathology of Conegliano Veneto City Hospital, Conegliano Veneto, Italy, 16 cases of papillary breast carcinoma diagnosed by fine-needle aspiration cytology have been selected. A multiparametric morphologic study has been performed in order to contribute to the cytologic characterization of this rare group of breast malignancies. The authors believe that aspiration biopsy cytology is able to provide an accurate preoperative diagnosis.     

Aspiration biopsy cytology of mesothelioma

From 1977 to 1986, 39 cases at our institution were diagnosed as "consistent with mesothelioma" by percutaneous fine-needle aspiration biopsy. All were verified clinically and/or histologically, with no false-positive results. All mesotheliomas except four tumors of peritoneal origin originated from the pleura. On the basis of their cytomorphologic features in correlation with histopathology, the tumors were classified into four types: benign, carcinomatous, sarcomatous, and undifferentiated. Of these 39 cases of mesothelioma diagnosed by aspiration biopsy, nine were benign type; 14, carcinomatous type; 13, sarcomatous type; and three, undifferentiated type. The cytomorphologic features and patterns of different types of mesotheliomas observed in aspirate preparations are presented, and the differential diagnosis is discussed. It appears feasible to investigate pleural- or peritoneal-based lesions with fine-needle aspiration biopsy, particularly in patients without effusions or with negative results in effusion examinations. It is also possible to make a definitive diagnosis of mesothelioma on the basis of cytologic findings coupled with special and immunoperoxidase staining in combination with roentgenographic findings and clinical history.     

Aspiration cytology of lipomatous tumors: A 10-year experience at an orthopedic oncology center

The cytodiagnoses of preoperative fine-needle aspirate smears from 72 histologically proven lipomatous tumors (52 lipomas and 20 liposarcomas of varying type) collected during the 10-yr period 1972–1981 were correlated to the corresponding histopathologic diagnoses. Three out of 52 lipomas were erroneously diagnosed as low-grade malignant liposarcomas, and one out of 20 liposarcomas was falsely diagnosed as a benign soft-tissue tumor. Of the 20 liposarcomas, 15 were cytologically diagnosed as such, and the majority of the myxoid and the pleomorphic liposarcomas were correctly diagnosed as to type. Important differential diagnostic problems were, on one hand, the separation of lipoma with regressive changes and histiocytic reaction and lipoma with chondroid metaplasia from low-grade malignant liposarcoma and, on the other hand, liposarcoma from intramuscular myxoma, myxofibrosarcoma, and malignant fibrous histiocytoma. The differential diagnosis of liposarcoma as opposed to other soft-tissue sarcomas is discussed, and it is concluded that preoperative fine-needle aspiration of lipomatous tumors is of value in the management of these tumors. Diagn Cytopathol 1987;3:295–302.     

Malignant fibrous histiocytoma of bone: initial diagnosis by aspiration biopsy cytology

Aspiration biopsy cytology by fine needle is becoming a popular diagnostic procedure for soft-tissue lesions; it also can be used successfully to diagnose some lesions from bone. The value of this procedure for making the initial diagnosis is illustrated by a case in which a malignant fibrous histiocytoma from a skull bone afflicted with Paget's disease was aspirated and interpreted as a sarcoma. This was later confirmed and subclassified by histology and electron microscopy from the tissue.     

The aspiration cytology of pulmonary hamartomas

Cytodiagnosis of pulmonary hamartomas (PHs) by transthoracic fine-needle aspiration (FNA), successful in 11 of a series of 14 cases, has been found to rely less on the presence of mature cartilage than on the recognition of fibromyxoid fragments. These fragments, wispy yet discrete, consisting of variable numbers of fibroblasts embedded in fibrillary ground substance, can be distinguished from fibrous tissue and mucus, both of which they may resemble. Mature cartilage is distinctive when present, but it is seen in a minority of cases. Bronchial cells and adipocytes, integral components of PHs, are of no diagnostic value unless associated with fibromyxomatous tissue or cartilage. Chest wall "contaminants" that may cause pitfalls in diagnosis, such as bone, skeletal muscle, and fibrous tissue, are described and illustrated. The differential diagnosis of biphasic lesions containing epithelial cells and mesenchyme, including dermoids and blastomas, is discussed. With knowledge of the radiologic appearance of target lesions, confident cytodiagnosis of PHs is possible if attention is paid to subtle, yet specific, background features in aspirated material.     

Fine-needle aspiration cytology of mammary fibromatosis: Report of two cases

The purpose of this study is to evaluate cytologically two cases of mammary fibromatosis (MF). Prior to FNAC, clinical and mammographic suspicion of carcinoma and fibroadenoma were present. In both cases cytology disclosed the presence of numerous spindle cells admixed with epithelial cells. In the first case, carcinoma was excluded and the diagnosis of “spindle-cell proliferative lesion” was established. The second case was erroneously diagnosed as “cellular fibroadenoma” due to the presence of monolayered ductal epithelial groups and stromal tissue. In both cases local excision of the lesion was recommended. Although in a strict sense fibromatosis is a pure stromal lesion, the frequent presence of epithelial groups in the smears should raise a differential diagnosis with other more frequent mixed (epithelial and stromal) lesions such as fibroadenoma, cystosarcoma phyllodes, and metaplastic carcinoma. Due to the fact that clinically and mamographically MF is frequently confused with malignancy, preoperative recognition is essential since in many cases it would avoid unnecessary radical surgery. In this sense cytology offers very important preoperative information. Diagn. Cytopathol. 1997;17:363–368. © 1997 Wiley-Liss, Inc.     

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.     

Comparison of fine-needle aspiration cytology and core biopsy for diagnosis of breast cancer

Both fine-needle aspiration (FNA) cytology and core biopsy are useful in the diagnosis of breast cancer. In order to compare the sensitivities of these procedures, we reviewed 209 patients with breast cancer who had either FNA, core biopsy, or both, and also either mastectomy or lumpectomy. Sensitivities for FNA and core biopsies for diagnosing breast cancer were calculated and compared. Sensitivity for FNA or core biopsies interpreted as either atypical or malignant was 93.8% for FNA and 90.1% for core biopsy (P > 0.05). Sensitivity for FNA or core biopsies interpreted as malignant was 65.4% for FNA and 88.7% for core biopsy (P < 0.0001). Sensitivities of FNA interpreted as either atypical or malignant were 92.4% for FNA performed by pathologists and 100% for FNA by nonpathologists (P > 0.05). Sensitivities of FNA interpreted as malignant were 75.8% for FNA by pathologists and 20.0% for FNA by nonpathologists (P < 0.00001). Both FNA and core biopsies are sensitive procedures for the detection of breast cancer. There was no significant difference between sensitivity of FNA and core biopsies interpreted as either atypia or malignancy, although the sensitivity of core biopsies interpreted as unequivocal malignancy was greater than that of FNA. FNAs performed by pathologists were more sensitive than FNAs performed by nonpathologists in making an unequivocal diagnosis of breast cancer.     

Aspiration biopsy cytology of metastatic endometrial stromal sarcoma and extragenital mixed mesodermal tumor

Aspiration biopsy from metastatic tumors in two cases of endometrial stromal sarcoma and one case of endometrial adenosarcoma revealed malignant endometrial stromal cells with ill-defined cytoplasm and round or oval hyperchromatic nuclei showing irregular chromatin clumping and conspicuous nucleoli. They were seen mainly in clusters. Aspirate from a metastatic tumor of a mixed mesodermal tumor arising from the omentum showed similar malignant endometrial stroma cells, irregular tight clusters of malignant glandular cells having scanty but well-defined cytoplasm and vesicular nuclei with conspicuous nucleoli, and fragments of atypical smooth muscle tissue. The diagnostic malignant endometrial stromal cells in those reported cases did not display any distinctive cellular features permitting their cytologic identification. They were difficult to differentiate from those of other types of sarcoma. In a clinical setting, with a known primary endometrial stromal sarcoma or mixed mesodermal tumor, however, a cytodiagnosis of its metastases may be suggested when malignant endometrial stromal-cell-like cells are seen in aspirated material, oviating an open-tissue biopsy.     

Aspiration biopsy cytology of intranodal myofibroblastoma: Case report with immunocytochemical analysis

Intranodal myofibroblastoma (IM) is a recently delineated clinicopathologic entity represented by a myofibroblastic proliferation of the lymph node. It usually occurs at the groin and presents clinically as a single enlarged lymph node. Its clinical behavior is entirely benign and local excision is curative. The authors herein report a case of IM diagnosed by aspiration biopsy cytology (ABC). The main diagnostic clues to the cytologic diagnosis of this entity as well as the differential diagnosis are presented. © 1995 Wiley-Liss, Inc.     

Aspiration biopsy of granulosa-cell tumor of the ovary: cytologic findings and differential diagnosis.

Fine-needle aspirates from four histologically confirmed adult granulosa-cell tumors of the ovary revealed irregular sheets, loose aggregates or tight clusters of small tumor cells with round or oval nuclei and scant cytoplasm. Nuclear grooves and indentations were noted in a small number of cells in two cases. Tumor cells arranged in follicular pattern mimicking Call-Exner bodies were not identified in all cases. A cytologic differential diagnosis of "small-cell" tumors of the ovary is briefly discussed.     

Aspiration cytology of primary thyroid paraganglioma

Thyroid paragangliomas are extremely rare tumors arising from the inferior laryngeal paraganglia. Most patients are female and present as asymptomatic thyroid nodule. Diagnosing thyroid paraganglioma can be difficult on fine‐needle aspiration (FNA) since it could be misdiagnosed as medullary thyroid carcinoma, calcitonin‐negative neuroendocrine tumor of the thyroid gland (CNNETT), metastatic neuroendocrine tumor, and intrathyroid parathyroid proliferation. We describe the cytologic features and immunohistochemical staining pattern of thyroid paraganglioma from a 60‐year‐old woman with a gradually enlarging neck mass for several months. An ultrasound guided fine‐needle aspiration was performed which revealed epithelioid, plasmacytoid to occasionally spindle‐shaped cells with ovoid to elongated nuclei, fine chromatin pattern and inconspicuous nucleoli. The cells were arranged singly, in sheets, and focally in acinar pattern. Occasional nuclear overlapping, crush artifact, and binucleated cells were identified. Neither colloid nor amyloid was seen. Immunohistochemical stains performed on the cell block showed the tumor cells were positive for neuroendocrine markers and negative for cytokeratin (AE1/AE3), calcitonin, CEA, thyroglobulin, and TTF‐1. There were rare S‐100 positive cells. Given the difference in management of paragangliomas compared to its cytology mimics and association with familial cancer syndromes in some cases, awareness of this rare tumor, and use of immunohistochemical stains are critical in arriving at the diagnosis. Diagn. Cytopathol. 2015;43:838–843. © 2015 Wiley Periodicals, Inc.