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.     

Fine‐needle aspiration of brown tumor of bone: Cytologic features with radiologic and histologic correlation

We report the case of a 40‐year‐old man with tertiary hyperparathyroidism due to end stage renal disease who initially presented with acute‐onset paraplegia, elevated serum parathyroid hormone, and multiple bone abnormalities, including a large extradural intraspinal mass seen by magnetic resonance imaging. In contrast with imaging features, fine‐needle aspiration cytology showed numerous benign‐appearing multinucleated osteoclast‐type giant cells that are the characteristics of either brown tumor or benign giant cell tumor of bone. Sheets of mononuclear spindled stromal cells were also noted. A core‐needle biopsy confirmed the diagnostic features of brown tumor of hyperparathyroidism. Diagn. Cytopathol. 2009. © 2008 Wiley‐Liss, Inc.     

Fine‐needle aspiration cytology of adenoid cystic carcinoma of the breast

Adenoid cystic carcinoma (ACC) of the breast is a rare variant of breast malignancy and has a better prognosis than its counterpart in the salivary glands. In this communication, our experience with seven cases of ACC of the breast is presented in which the diagnosis was established on fine‐needle aspiration cytology (FNAC). The cytologic samples in all cases were cellular and featured three‐dimensional clusters of uniform ductal epithelial cells with cystic spaces, bland nuclei, fine chromatin, and scanty cytoplasm arranged around spheres or cores of homogenous material. The cytodiagnosis of ACC in all cases correlated with subsequent examination of cell blocks of the aspirate and tissue. The cytodiagnostic criteria for ACC of the breast which are useful in a correct FNAC diagnosis are discussed. Diagn. Cytopathol. 1999;20:82–84. © 1999 Wiley‐Liss, Inc.     

Fine needle aspiration cytology of lobular carcinoma in situ on ThinPrep

Lobular carcinoma in situ (LCIS) of the breast is a recognized marker for increased risk of invasive carcinoma and has well-established histologic criteria. However, its detection and diagnosis on FNA of breast has not been well defined. Cytology slides (all ThinPrep) of 11 cases with biopsy-proven LCIS at Beth Israel Deaconess Medical Center were reviewed. All 11 cases showed tight and/or loosely cohesive clusters of crowded mildly enlarged nuclei and ten of 11 showed at least moderate cellularity. Single epithelial cells, small but prominent nucleoli, intracytoplasmic lumina, and two distinct epithelial-cell populations were also noted in some cases. As none of these features is specific for LCIS, it would be prudent to report such lesions as atypical so that a core biopsy or excisional biopsy will be performed before definitive treatment. The original FNA diagnosis of the 11 cases ranged from epithelial proliferation without atypia to carcinoma. Three of the 11 cases had fibroadenomas on histology with extensive involvement by LCIS. Since management for LCIS is different from that for invasive carcinoma or DCIS, it should be considered and distinguished from the latter two in cases suspicious for carcinoma on FNA.     

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.     

Cytomorphologic features of fine‐needle aspiration of liposarcoma

The cytomorphologic features of fine‐needle aspirates (FNA) of liposarcomas have not been fully characterized. In the current study, we attempted to identify cytological attributes of liposarcoma in FNA. Twelve FNAs of histologically proven liposarcomas were used for this study. They included 10 myxoid and two well‐differentiated liposarcomas. Four cytological criteria were chosen for evaluation. These included a complex capillary network, increased cellularity, the presence of a metachromatic stroma for myxoid liposarcoma, and finally the identification of lipoblasts. Eighteen FNAs of lipomas and 17 FNAs of nonlipomatous soft‐tissue sarcomas were used as controls for evaluation of the same features. The diagnosis of liposarcoma had been rendered on FNA in 7 cases (58%). The diagnosis was suggested in 3 cases (25%), and a suggestion of sarcoma was rendered in 2 cases. Complex capillary networks were identified in 9 of 12 cases (75%); this was seen in 8 of the 10 myxoid liposarcomas and 1 of the 2 well‐differentiated neoplasms. Increased cellularity was seen in 7 of 12 cases (58%), metachromatic stroma was seen in 3 of 12 cases (25%), and lipoblasts were identified in 4 of 12 cases (33%). None of the lipomas or sarcomas exhibited a complex capillary network. When capillaries were identified in lipomas, they were straight, with minimal branching. The lipomas did not show evidence of increased cellularity in any cases. Metachromatic stroma was more frequently seen in the nonlipomatous sarcomas than in the liposarcomas. No lipoblasts were identified in any of the control FNAs. Diagn. Cytopathol. 1999;20:67–69. © 1999 Wiley‐Liss, Inc.     

Fine‐needle aspiration cytology of an adenoid cystic carcinoma of trachea: Common tumor in uncommon location

Adenoid cystic carcinoma (ACC) is most often primary in the major and minor salivary glands but can also arise from the submucosal seromucinous glands of the larynx and trachea. We report a case of ACC of the larynx that presented as a recurrent cough for 4 months and vomiting 3 to 4 times within 1 month. Fine‐needle aspiration cytology was consistent with an ACC. Subsequent cell block and immunocytochemistry confirmed the diagnosis. This case highlights the need to be aware of unusual lesions that may arise in the region of trachea.     

Fine‐needle aspiration cytology of solid papillary carcinoma of the breast

We report a case of solid papillary carcinoma (SPC) of the breast, of which the cytologic findings of the nipple discharge and the fine needle aspiration (FNA), and the pathology of the resected tumour are described in detail. Imaging studies demonstrated an intra‐ductal tumour of the breast, which seemed responsible for the bloody nipple discharge. The cytologic features of the nipple discharge and the FNA targeted to the intra‐ductal tumour suggested low‐grade carcinoma. Additional findings of mucin production and rosette‐formation (possibly neuroendocrine differentiation) indicated SPC as a major differential diagnosis. Histologically, the lesion consisted of mainly ductal proliferation of low‐grade carcinoma associated with prominent rosette formation within the tumour and mucin production. Permeation of mucin with cancer cell clusters into the adjacent adipose tissue was also noted. Immunohistochemically, the tumour cells, especially those forming rosettes, were partially positive for CD56. Histological diagnosis was SPC with invasion. SPC is a rare tumour, and its cytologic and pathologic features have only been sporadically reported. Our case was unique in that there was a good correlation between cytologic and histologic findings. The cytologic findings that are important to predict the histologic diagnosis are emphasized. A brief review of the relevant literature is also included.     

Fine‐needle aspiration of tubulocystic renal cell carcinoma

We report two cases of tubulocystic renal cell carcinoma, a rare renal tumor the cytology of which has not been previously reported. Both aspirates were cellular and contained large sheets of cells with abundant granular cytoplasm, distinct cell borders and intracellular windows, distinct to prominent nucleoli, rare intracytoplasmic vacuoles, and rare nuclear grooves. Cells with variable amounts of cytoplasm were also arranged in small groups, some of which resembled spherules. The large sheets of cells with windows appeared specific for tubulocystic carcinoma; the spherules could easily be confused with a papillary renal cell carcinoma.     

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.     

Fine‐needle aspiration cytology of metastatic eccrine porocarcinoma

Eccrine porocarcinoma (EP), although rare, is widely recognized as the most common malignant sweat gland tumor. EP typically grows slowly and usually is cured by surgical excision with clear margins. An elevated mortality rate, however, is observed when regional lymph nodes are involved. We herein describe cytohistologic findings in a case of metastatic EP. An 86‐year‐old man with a history of EP of the left lateral ankle and squamous cell carcinoma in situ (Bowen's disease) of the penis presented with enlarged left inguinal lymph nodes. A superficial fine‐needle aspiration (FNA) was performed and demonstrated a hypercellular sample with discohesive clusters and/or individual tumor cells. The tumor cells were round or oval with most of the cells showing dense, refractile cytoplasm. Intracytoplasmic vacuoles were readily appreciated in some of the cells. Nuclear enlargement, high N/C ratio, nuclear hyperchromasia, bi‐ and multinucleation, and prominent nucleoli were seen. A diagnosis of metastatic eccrine porocarcinoma was rendered. Enlarged retroperitoneal lymph nodes were detected and CT‐guided left retroperitoneal core biopsy was performed 1 week later. The biopsy revealed features consistent with metastatic eccrine porocarcinoma. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Mucinous breast carcinoma metastatic to thyroid gland: Report of a case diagnosed by fine‐needle aspiration cytology

Mucinous breast cancer is a slow‐growing neoplasm, which has fewer lymph node metastases and favorable prognosis compared with invasive breast cancer no special type. The hematogenous spread of breast mucinous carcinoma is very rare. Though breast cancer involving thyroid has been reported before, there is still no report about thyroid metastatic breast mucinous carcinoma in the literature. Recently by performing thyroid fine‐needle aspiration, a 58‐year‐old woman who had breast cancer 13 years ago was diagnosed as thyroid metastatic mucinous breast carcinoma, cellular variant with neuroendocrine differentiation. For this patient, the thyroid was the only involved site without widespread metastatic diseases, so thyroidectomy and the right cervical lymph nodes dissection were performed to make better survival. As a result, the patient had not shown any signs of recurrence 9 months after the thyroid surgery.     

Fine needle aspiration cytology of cylindroma of scalp: A case report

Cylindromas are uncommon benign adnexal tumor. Multiple cylindromas are commonly genetically inherited and also known as “turban tumor.” Cytology of dermal cylindroma is rarely discussed in previous literature. We have diagnosed a case of dermal cylindroma of scalp in an elderly female patient by fine needle aspiration cytology of the lesion and further confirmation was done by histopathology. Cytology consists of many clusters of small round to oval basaloid cells surrounded and attached with magenta coloured acellular hyaline material. The cells have very scanty cytoplasm and dark, round to oval hyperchromatic nuclei without any nuclear membrane irregularity. Histopathology revealed nests of tumor cells separated by dense pink, PAS positive basement membrane material with a jigsaw puzzle appearance. Cytology of cylindroma should be differentiated from adenoid cystic carcinoma and other benign adnexal tumor like spiradenoma. We have discussed the case of cylindroma of scalp diagnosed by cytology and confirmed by histopathology. Diagn. Cytopathol. 2016;44:1082–1084. © 2016 Wiley Periodicals, Inc.