Cytologic features of fibrolamellar carcinoma with mucin production: A rare variant of combined hepatocellular‐cholangiocarcinoma

Fibrolamellar carcinoma (FC) is an uncommon tumor that usually arises in non‐cirrhotic livers of adolescents or young adults. It differs clinically from hepatocellular carcinoma in its better prognosis and lack of gender predilection. Cytologically, the tumor is composed of large polygonal cells with abundant cytoplasm, pleomorphic nuclei, and prominent large nucleoli. A variant of FC with mucinous differentiation has been previously described. These tumors have been regarded as combined hepatocellular cholangiocarcinomas. Herein, we report the case of a 44‐year‐old Asian female with a large liver mass present for approximately two years. Core needle biopsy with imprint cytology demonstrated FC with areas of intracellular mucin. To our knowledge, cytological features of this rare tumor have not been described before. Diagn. Cytopathol. 2014;42:431‐435. © 2012 Wiley Periodicals, Inc.     

High‐grade epithelial‐myoepithelial carcinoma of the parotid gland with mucous cell differentiation

Epithelial‐myoepithelial carcinoma (EMC) is a rare salivary gland tumor with a low‐grade malignancy, and EMC with high‐grade histopathological features is exceedingly rare. Furthermore, EMC with intracellular mucin is also extremely rare. We report an uncommon case of a high‐grade EMC of the parotid gland with mucous cell differentiation in a 66‐year old Japanese woman who noticed a right palpable parotid mass increasing in size within a one‐year period. The cytological specimen showed a focally biphasic structure and included isolated or discohesive piled‐up clusters with hyaline globules surrounded by neoplastic cells with nuclear atypia. The gross examination revealed a relatively well‐demarcated, multinodular gray‐whitish and solid mass. Histologically, the tumor consisted of variably sized solid nests or trabeculae with central necrosis and increased mitotic activity, and invaded into adjacent skeletal muscles. Immunohistochemically, the biphasic ductal and myoepithelial differentiation of this tumor confirmed the diagnosis of high‐grade EMC. Furthermore, numerous small nests with d‐PAS and alcian blue‐positive mucous cells predominated in about 5% of the whole tumor, and these mucous cells were encompassed by neoplastic myoepithelial cells. We should recognize this variant of EMC because we can't rule out the possibility of EMC even in the presence of mucous cells.     

Cutaneous metastasis from a myoepithelial carcinoma of submandibular salivary gland

Myoepithelial carcinoma is a rare malignant tumor of salivary gland with locally aggressive nature and potential for distant metastasis. It is composed of tumor cells with myoepithelial differentiation showing varied cytomorphology. Lungs and kidneys are the commonest sites for distant metastasis. Cutaneous metastasis of myoepithelial carcinoma is very rare. In this report, we described cutaneous metastasis of myoepithelial carcinoma arising from submandibular gland. Diagn. Cytopathol. 2015;43:53–56. © 2014 Wiley Periodicals, Inc.     

Cytogenetic analysis of myoepithelial cell carcinoma of salivary gland

Myoepithelial cell carcinoma (MCC) of the salivary gland is a rare entity. Here, we describe the karyotype of MCC. The patient was a 53-year-old man, with a rapidly growing lesion of the palate. Despite complete surgical excision, radio- and chemotherapy, the lesion rapidly harboured local and distant metastases leading to the death of the patient, 4 months after the diagnosis. On histological and ultrastructural examination, the primary tumour and the related metastases were composed of oval and spindle cells, with features of myoepithelial cell differentiation reported in the literature. Cytogenetic analysis showed a composite karyotype in the primary tumour: 45~46,XY, +3[cp3]/ 44~45,XY, -17[cp4]/ 46,XY[5]. The lymph-node metastasis was near-triploid and showed a complex karyotype. Our cytogenetic data differ from those described in benign or slowly growing salivary gland tumours showing myoepithelial cell differentiation. It is suggested that highly aggressive tumours might follow a different pathway of malignant transformation.     

Cytological features of the Warthin‐like variant of salivary mucoepidermoid carcinoma

Warthin‐like mucoepidermoid carcinoma is a recently proposed variant of musoepidermoid carcinoma. Histologically, it is characterized by its close resemblance to Warthin tumor, including dense lymphocytic infiltration, flattened intermediate epithelium resembling squamous metaplasia, and cystic change. Given its histologic similarity to Warthin tumor, confirmatory testing for MAML2 rearrangement is often required for this diagnosis. Here we present the first cytologic reports of two 53‐year‐old female patients with parotid masses. In both cases, the fine needle aspirations showed fragments of bland epithelium with a squamous appearance, mucinous cyst content, and focal lymphocytic background. Neither frank keratinization nor mucinous cells were identified in the smears. Fluorescence in situ hybridization (FISH) study confirmed MAML2 rearrangement on the resection specimens in both. Other cytologic differential diagnoses, including Warthin tumor with metaplasia, lymphadenoma, and lymphoepithelial cyst, were briefly discussed.     

Sarcomatoid salivary duct carcinoma of minor salivary gland: a rare case

A 35-year-old female presented with swelling in the soft palate. Fine needle aspiration cytology (FNAC) revealed pleomorphic adenoma, and on histopathological examination, it was diagnosed as carcinosarcoma/salivary duct carcinoma in the minor salivary gland, which was confirmed by immunohistochemical stains. We report this case for its rarity.     

Cytologic features of papillary-cystic variant of acinic-cell adenocarcinoma: A case report

A case of papillary-cystic variant of acinic-cell adenocarcinoma is described. The cytologic findings differed significantly from the classic features of this tumor with smears showing large monolayer sheets and small papillary groups, no acinic structures or naked tumor cell nuclei, sparse cell dissociation and many vacuolated cells. © 1994 Wiley-Liss, Inc.     

Fine‐needle aspiration cytomorphology of sebaceous lymphadenoma of the salivary gland

Sebaceous lymphadenoma (SLA) is a histologic variant of lymphadenoma or sebaceous adenoma of the salivary gland. The fine‐needle aspiration (FNA) cytology of SLA has not been well‐described. In this report, we reported a case that involved an 81‐year‐old male with a long‐standing left parotid mass and was diagnosed on FNA cytology. The FNA smears showed clusters of three types of epithelial cells in a background of abundant lymphoid cells, macrophages and abundant proteinaceous materials. The predominant epithelial cells were large polygonal cells with abundant cytoplasm filled with multiple, uniform, small, and clear vacuoles, ill‐defined cytoplasmic borders, and small centrally located round nuclei with finely granular chromatin, conspicuous nucleoli and indented nuclear membranes apparently imprinted by cytoplasmic vacuoles. These cells were surrounded by polygonal or flat cells with less or more dense cytoplasm, indistinct cell borders and round or oval small nuclei with smooth nuclear membranes, which correspond to germinative or basaloid cells. Some cells had granular cytoplasm. Large three dimensional clusters of nonkeratinized squamous cells have oval nuclei containing evenly distributed chromatin, and scant to moderate dense cytoplasm that were arranged in a “stream of fish” pattern. Rare granulomas and cystic contents (degenerated cells, inflammatory cells, macrophages, and abundant granular debris/proteinaceous material) were also seen. The diagnosis of SLA was confirmed by the surgical resection. Diagn. Cytopathol. 2014;42:959–963. © 2013 Wiley Periodicals, Inc.     

Going beyond “Basaloid neoplasm”: Fine needle aspiration cytology of epithelial‐myoepithelial carcinoma of the parotid gland

Epithelial‐myoepithelial carcinoma (EMC) is a rare salivary gland malignancy with variable cytologic findings. Its rarity, variable morphologic findings, and similarities with more common salivary gland entities make it a difficult cytologic diagnosis. As the name signifies, the key feature of this tumor is presence of an epithelial and myoepithelial component. However, when one of these two components is scant on the fine needle aspiration (FNA) smears, it may be overlooked. We present a case from a 62 year‐old female who presented to the clinic with a parotid nodule and episodes of sharp, throbbing pain. A fine needle aspiration was performed which revealed a highly cellular specimen comprised primarily of aggregates of cells with small, round nuclei and scant to absent cytoplasm. Abundant hyaline stromal material was also noted. The case was signed out as basaloid neoplasm with a recommendation for surgical resection. The subsequent resection specimen revealed EMC. By reviewing the FNA specimen following the surgical resection of the tumor, we were able to utilize the benefit of hindsight to more clearly identify the subtle, biphasic components of the tumor. Diagn. Cytopathol. 2016;44:422–425. © 2016 Wiley Periodicals, Inc.     

Cytologic features of insular carcinoma of the thyroid: a case report

Fine-needle aspiration of the thyroid has been accepted as one of the initial diagnostic tools in the evaluation of thyroid nodules. As its use becomes more widespread, the demand for more precise diagnosis has increased. The histopathology of insular carcinoma of the thyroid is now well recognized. However, the cytologic diagnostic criteria are not well established. The reported series have been small (4-6 cases), which is not surprising because of the rarity of this tumor. They consist of retrospective reviews of the aspirates (after the histologic diagnosis had been made from the thyroidectomy specimens). Also, the case reports do not provide uniform cytologic criteria; this could be due to limited sampling of these tumors (which are usually large). A cytologic diagnosis of insular carcinoma can be suggested if multiple samples of a thyroidal mass are markedly cellular, with a cytologic pattern reminiscent of a follicular variant of papillary carcinoma. However, the follicular cells are arranged predominantly in rosettes, their nuclei appear more monotonous, some "intranuclear cytoplasmic pseudoinclusions" are seen, and there is an occasional large cell with a pleomorphic nucleus.     

Cytologic features of vaping‐induced lung injury: A case report

Vaping‐induced lung injury is a recently recognized phenomenon owing to the rising popularity of e‐cigarette use. A cluster of cases of varying severity, including six deaths, was recently reported in the United States by the Centers for Disease Control. The objective of this report is to highlight the cytologic features suggestive of vaping‐induced lung injury. A 20‐year‐old previously healthy man presented with a 7‐day history of progressively worsening respiratory symptoms including dyspnea on exertion, cough, and fever, with no improvement after initiating a course of antibiotics. No relevant travel or occupational history was reported, but patient endorsed daily use of e‐cigarette with a fluid containing both tetrahydrocannabinol and nicotine. Radiographic studies demonstrated scattered areas of interlobular septal thickening and diffuse ground‐glass opacities in both lungs. Laboratory tests for HIV and influenza were negative. Bronchoscopy and bronchoalveolar lavage were performed, with cytologic study showing clusters of benign bronchial cells and an increase in lipid‐laden macrophages by Oil Red O stain. Patient was placed on steroid and steadily improved for the next 2 days. He was discharged on a steroid taper and follow‐up with respiratory clinic. Case reports and series have shown a variety of lung injury patterns in previously healthy patients who are frequent users of e‐cigarettes and among them features suggestive of lipoid pneumonia with increased lipid‐laden macrophages. The clinical utility of this finding is still unclear.     

Epithelial-myoepithelial tumor of the salivary gland. Cytologic and histologic features]

The histological and cytological pictures of epithelial-myoepithelial carcinoma of parotid gland were described. It was pointed out, that in the Polish literature these tumours were previously called clear cell adenoma.     

Plasmacytoid variant of urothelial carcinoma: A report of a rare case

Plasmacytoid variant of urothelial bladder carcinoma is rare. We report a case with a detailed discussion of features that help characterize this variant. A 50-year-old man originally presented with gross hematuria. Resections at that time revealed a grade I-II superficial urothelial carcinoma. He did not return for follow-up until recently, three years later, when he presented with recurrent gross hematuria. An extensive tumor was identified on cystoscopy. Resection revealed a high-grade non-invasive papillary urothelial carcinoma. CT scan revealed a large urinary bladder solid mass with bilateral hydronephrosis. Metastatic workup was negative. The patient underwent a radical cystectomy with creation of ileal conduit. Final pathology revealed plasmacytoid variant of urothelial carcinoma with extensive vascular invasion and extension to the perivesical adipose tissue. We present a rare variant of urothelial carcinoma with comprehensive analysis of the morphological and immunophenotypic clues that characterize this variant.