Adenomyoepithelioma of the breast: Report of two cases with prominent cystic changes and intranuclear inclusions

Adenomyoepithelioma is a rare breast tumor. Histologically it may disclose different patterns of growth, and some additional features may result in diagnostic errors. We describe 2 cases of adenomyoepithelioma of the breast initially examined by fine-needle aspiration biopsy (FNAB). Cytologic features included hypercellularity, clusters of epithelial and myoepithelial cells with occasional intranuclear inclusions, prominent apocrine metaplasia, and foam cells. Histologically, both tumors were diagnosed as adenomyoepithelioma tubular-variant, with prominent myoepithelial clear cells, apocrine metaplasia, and foci of squamous metaplasia. Immunohistochemically, the tumors showed strong positivity for keratins CAM 5.2, AE1/AE3, and EMA in the epithelial component, while the myoepithelial cells reacted with muscle-specific actin (A14 and HHF35) and S-100 protein. We point out that FNAB in this rare tumor may exhibit a varied spectrum of cells that may result in confusion with other lesions, and we call attention to the presence of intranuclear inclusions. The latter observation in the present cases by cytologic and histologic assessment provides an additional feature to the morphological characteristics of adenomyoepithelioma of the breast. Diagn. Cytopathol. 1998;19:55–58. © 1998 Wiley-Liss, Inc.     

Fine-needle aspiration cytology and differential diagnoses of fibrolamellar hepatocellular carcinoma metastatic to the mediastinum: case report

We report a case of fibrolamellar hepatocellular carcinoma (FL-HCC) that metastasized to the posterior mediastinum. The diagnosis was made on fine-needle aspiration biopsy (FNAB). The cytologic features were characterized by the presence of large, dishesive, polygonal cells with granular cytoplasm and well-defined cell outlines resembling oncocytes. Groups of neoplastic hepatocytes containing bile pigment were also noted. The diagnosis of FL-HCC in a metastatic site can pose diagnostic challenges on FNAB. The cytologic features overlap with a variety of tumors that have oncocytic features and also with melanoma and paraganglioma. Recognition of specific cytologic features of FL-HCC can facilitate accurate diagnosis in a metastatic site. The cytologic findings and differential diagnoses of FL-HCC that metastasized to the posterior mediastinum are discussed.     

Odontogenic ghost cell tumor: A case report with cytologic findings

Odontogenic ghost cell tumor is a rare, neoplastic form of calcifying odontogenic cyst (Gorlin cyst) whose cytologic features have not been previously reported. We present a case of odontogenic ghost cell tumor diagnosed by fine-needle aspiration biopsy (FNAB). The aspirate was characterized by (1) tissue fragments with basaloid epithelial cells, (2) “ghost” cells, (3) scattered multinucleated giant cells, (4) rare, eosinophilic, densely hyalinized “dentinoid” material in close association with the basaloid cells, and (5) calcific debris. The aspirate was diagnosed as “consistent with odontogenic ghost cell tumor.” The cytologic features of odontogenic ghost cell tumor, as described, closely parallel the major histologic findings in this rare tumor. The differential diagnoses include other odontogenic tumors, squamous cell carcinoma, basaloid cell tumors of the salivary gland, and pilomatrixoma. Diagn. Cytopathol. 1998;18:199–203. © 1998 Wiley-Liss, Inc.     

Fibroadenomas with atypia: causes of under- and overdiagnosis by aspiration biopsy.

Fibroadenoma (FA) is a common benign breast lesion frequently sampled by fine-needle aspiration biopsy (FNAB). Although the cytologic diagnosis is straightforward in most cases, cellular discohesion and atypia in FAs may lead to falsely atypical or positive FNAB diagnoses. Conversely, some adenocarcinomas mimic a fibroadenomatous pattern on FNAB, resulting in a false-negative diagnosis. We reviewed the cytologic and histologic findings in 25 cases with a preoperative FNAB diagnosis of FA, wherein excision was recommended based on atypia. Our aim was to analyze the spectrum of changes causing under- or overdiagnosis in such cases. The smears were assessed for cellularity, cellular discohesion, presence of dissociated intact cells and nucleoli, nuclear pleomorphism, oval bare nuclei, and stromal fragments. The histologic findings were correlated with FNAB features. At excision, 88% of FAs classified as atypical on FNAB were benign (FA with ductal hyperplasia and lactational change, myxoid FA, and other fibroepithelial lesions). Differentiating myxoid FA from colloid carcinoma was difficult due to the abundance of extracellular mucin in which the dissociated epithelial cells were floating. Two (8%) cases were carcinomas on excision; the reasons for underdiagnosis in one case reflected sampling, and in the other, interpretative error. There was one (4%) benign phyllodes tumor which lacked stromal fragments and single stromal cells on FNAB smears. The lesion was called atypical, based on the epithelial discohesion on the smears. We conclude that the majority of FAs with atypia on FNAB are benign lesions. Considering the grave consequences of a false-positive cytologic diagnosis, we recommend a conservative approach in interpreting FNAB smears which overall display a fibroadenomatous pattern.     

Epithelioid hemangioendothelioma of bone and soft tissue: A fine-needle aspiration biopsy study with histologic and immunohistochemical confirmation

We retrospectively reviewed two fine-needle aspiration biopsy (FNAB) specimens from two patients with histologically confirmed epithelioid hemangioendothelioma (EH). Both patients were men, ages 79 and 39 years; their primary tumors arose in the soft tissues of the mediastinum and within the proximal tibia, respectively. The former patient had symptoms of superior vena cava syndrome; multicentric intraosseous lesions involved the proximal tibia of the latter patient. All cytologic smears were hypercellular and composed of mostly disassociated single cells and small aggregates of ovoid to polygonal-shaped epithelioid cells. Nuclei were variable, ranging from ovoid and reniform to round and polylobated and surrounded by an abundant amount of dense cytoplasm. Binucleated epithelioid neoplastic cells were frequent. Nuclear pleomorphism ranged from slight to moderate, and small solitary to multiple nucleoli were identified within the majority of tumor cells. Rare neoplastic cells with a single, sharply demarcated intracytoplasmic vacuole and intranuclear cytoplasmic pseudoinclusions were observed in the smears of one tumor. Metachromatic stromal fragments, probably representing hyalinized chondromyxoid stroma, were seen in the other tumor. Neither case was recognized initially on FNAB as EH. Immunohistochemically, sections from the surgical biopsy specimens of both cases showed diffuse and strong immunopositivity for the endothelial marker CD31. Although the cytomorphology of EH appears distinct, clinicoradiologic correlation is essential, and immunohistochemistry may be helpful to avoid misdiagnoses. Diag. Cytopathol. 1998;19:38–43. © 1998 Wiley-Liss, Inc.     

Role of fine-needle aspiration biopsy in breast lesions: Analysis of a series of 4,110 cases

From January of 1990 to December of 1992, 6,954 consecutive cytologic breast fine-needle aspiration biopsies (FNAB) were performed at the Laboratory of Pathology of Sant'Anna Hospital in Turin. Of these cases 62% were solid nodes, 35% were cystic nodes, and 2.7% were nonpalpable breast lesions (stereotaxic or ultrasound guided FNAB). We verified 4,110 cases: 913 cases underwent surgery and 3,197 were evaluated clinically, and/or cytologically, and/or with mammography at least 1 yr after the first diagnosis, or checked with the database of the Tumor Registry of Turin. In our series the FNAB sensitivity was 94.6%, specificity was 99.9%, accuracy was 98.8%, inadequate samples were 6.4%, false-negative rate was 1.4%, and false-positive rate was 0.3%. Our results indicate that the use of cell block improves sensitivity (from 85.2 to 94.6%) and strongly reduces false-negative results (from 3.9 to 1.4%). We conclude that FNAB is a discriminant procedure to the surgical biopsy in cases with clinical, ultrasound, or mammographic low or intermediate suspect, contributing to allow a high malignant/benign surgical biopsy rate and to reduce the need for frozen section diagnosis and medical costs. Diagn. Cytopathol. 1998;18:462–467. © 1998 Wiley-Liss, Inc.     

Fine-needle aspiration of nodular hidradenoma: A case report

A case of nodular hidradenoma presenting on the forearm of a 36 year old woman is reported. The diagnosis was made on fine-needle aspiration biopsy (FNAB). The cytologic features of the lesion are described. This is the first case to be diagnosed cytologically. Diagn Cytopathol 1996;15:395–397. © 1996 Wiley-Liss, Inc.     

Concomitant lymphoma and metastatic carcinoma in a lymph node: Diagnosis by fine-needle aspiration biopsy in two cases

Concomitant lymphoma and metastatic carcinoma are an unusual occurrence in a lymph node. We report two patients in whom synchronous malignancies were diagnosed by fine-needle aspiration biopsy (FNAB). In one case, the FNAB diagnoses of both small lymphocytic lymphoma and metastatic breast carcinoma were the initial diagnoses. In the second case, metastatic poorly differentiated squamous carcinoma was an unexpected finding in a patient with a history of small lymphocytic lymphoma. The aspirates in both cases showed two distinct cell populations, one consisting of a dispersed population of small uniform lymphoid cells and the other comprising large atypical single cells and cohesive clusters of epithelial cells. In both cases, the cytologic diagnoses were supported by immunohistochemical and flow cytometric studies. Diagn. Cytopathol. 1997;17:287–291, 1997. © 1997 Wiley-Liss, Inc.     

Fine-needle aspiration biopsy of solid aneurysmal bone cyst in the humerus

We report the fine-needle aspiration biopsy (FNAB) cytology findings of a solid aneurysmal bone cyst in the left humerus of a 69-yr-old woman. Radiographically, the lesion showed an extensive, relatively well-defined osteolysis in the diaphysis, with a pathologic fracture. FNAB smears of the lesion consisted of benign, mononuclear cells and numerous osteoclast-like multinucleated giant cells. Some clusters of the mononuclear cells were closely associated with dense, homogeneous, extracellular, matrix material. To our knowledge, the FNAB features of solid ABC of the long bones have not been described previously in the English-language literature. The cytologic features are indistinguishable from those of giant cell tumors of bone and brown tumors of hyperparathyroidism.     

Histiocytic aggregates in benign nodular goiters mimicking cytologic features of papillary thyroid carcinoma (PTC)

Macrophages/histiocytes are commonly seen in fine-needle aspiration biopsy (FNAB) specimens of thyroid nodules with varying degrees of cystic change. In some cases the histiocytic component of a cystic thyroid nodule can occur as large tissue fragments with marked nuclear atypia, including elongated nuclei with chromatin clearing, nuclear grooves, and membrane thickening. These nuclear changes mimic cytologic features of papillary thyroid carcinoma (PTC), thus leading to diagnostic difficulty in interpretation of FNAB specimens of benign cystic thyroid nodules. We evaluated ethanol-fixed Papanicolaou-stained smears of 273 cases of FNAB thyroid specimens from goitrous nodules with cystic change. Twenty cases were selected due to the presence of large aggregates of histiocytic cells with the above-mentioned nuclear atypia. An immunostain for histiocytic cells using CD68 was performed on alcohol-fixed slides. Histiocytic cells in tissue fragments with nuclear atypia mimicking PTC nuclei showed strong cytoplasmic staining for CD68; thyroid follicular cells stained negative for CD68. We conclude that histiocytic cells in cystic goitrous nodules can show nuclear features, which appear similar to PTC nuclei. Immunostaining for CD68 may be of value in differentiating between benign cystic thyroid nodules with histiocytic aggregates that mimic cytologic features of papillary carcinoma, and PTC with cystic change.     

Metastatic meningioma detected in pleural fluid

Meningiomas with both malignant cytologic features and clinical behavior are rare. A 39-yr-old man with recurrent meningioma developed a pleural effusion which, on cytologic examination, contained metastatic meningioma. The diagnosis was subsequently confirmed histologically and ultrastructurally. In conclusion, metastatic meningiomas can retain meningotheliomatous cytologic features which may allow a diagnosis to be made of clinically unanticipated tumor spread. Diagn. Cytopathol. 1998;18:453–457. © 1998 Wiley-Liss, Inc.     

Fine-needle aspiration biopsy of metastatic Ewing's sarcoma with MIC2 (CD99) immunocytochemistry

The use of fine-needle aspiration biopsy (FNAB) has been infrequently described as a diagnostic modality for Ewing's sarcoma (ES) patient follow-up and management. The purpose of this study is to examine the use and accuracy of FNAB combined with MIC2 immunocytochemistry for evaluating metastases in patients with ES. Records from Saint Louis University Health Sciences Center and Indiana University Medical Centers identified patients with known ES who had undergone FNAB for evaluation of potential metastases. Immunocytochemical analysis for MIC2 (CD99) was performed retrospectively on cell blocks and direct aspirate smears. FNABs from nine patients were procured either percutaneously or under radiologic guidance and in all cases a definitive cytologic diagnosis of metastatic ES was rendered. Aspirates were cellular with many single discohesive small round cells and occasional loosely cohesive clusters. The nuclei were round with a fine chromatin pattern and small nucleoli. The cytoplasm was scanty and the nuclear-cytoplasmic ratio was high. Six of six cases showed strongly positive immunocytochemical labeling for MIC2. Immunocytochemistry with MIC2 in FNAB aspirate smears can provide supportive evidence of ES in patients with known disease. Diagn. Cytopathol. 1998;19:382–384. © 1998 Wiley-Liss, Inc.     

Aspiration cytology of Wilms' tumor: correlation of cytologic and histologic features

We examined the cytomorphologic features of fine-needle aspiration biopsy (FNAB) specimens from 23 Wilms' tumor patients. The findings were correlated with histopathologic patterns from these tumors. The study revealed a close resemblance between the cytologic and histopathologic appearance of various cellular elements in Wilms' tumors. The major cellular patterns seen in Wilms' tumor include blastemal cells, blastemal cells with epithelial differentiation, blastemal cells with tubular differentiation, and stromal elements. It is hoped that recognition of these cellular components in aspiration smears will be helpful in establishing an FNAB diagnosis of Wilms' tumor.     

Neutrophil-rich Ki-1-positive anaplastic large cell lymphoma: a study by fine-needle aspiration biopsy

Fine-needle aspiration biopsy (FNAB) is an accurate, cost-effective method of evaluating lymphomas. The neutrophil-rich variant of anaplastic large cell lymphoma (NR-ALCL) is a rare non-Hodgkin lymphoma. To our knowledge, we present thefirst study of NR-ALCL by FNAB cytology. Histologic confirmation was available for both patients. Both cases were positive for Ki-1 (CD-30) and were either T-cell or null-cell phenotype. FNAB specimens were highly cellular with a single-cell pattern composed of pleomorphic tumor cells, "hallmark" tumor cells, and a background rich in neutrophils that occasionally obscured tumor cells. Diagnosis on FNAB is difficult owing to the rarity of this tumor, its resemblance to Hodgkin lymphoma and other non-Hodgkin lymphomas that express CD30, its similarity to an infectious process, and its occasional confusion with metastatic carcinoma and melanoma. Reproducible cytologic features usually are present, and the diagnosis can be made conclusively by FNAB in conjunction with ancillary studies.     

The accuracy of fine-needle aspiration cytology in the diagnosis of canine skin and subcutaneous masses

A retrospective evaluation of cytologic and histopathologic specimens from 300 cutaneous and subcutaneous palpable lesions in dogs was performed. Preoperatively, specimens were obtained from each formation by fine-needle aspiration biopsy (FNAB). Samples for histopathology were obtained by surgical excision biopsy or at necropsy. The concordance and the accuracy of FNAB for the diagnosis of neoplasia were determined using histopathology as a gold standard. Fifty-two cases were considered as unsatisfactory and were excluded from the study (retrieval rate 82.66%, n = 248). Neoplasia was diagnosed in 193 cytologic specimens. In 190 cases, neoplasia was confirmed by histology (98.44% true positive). Fifty-five cytologic specimens were classified as non-neoplastic. In 35 (63.63%) cases, the cytologic diagnoses were in agreement with the histologic diagnosis (true negative), while in 20 (36.37%) cases, a false negative diagnosis of neoplasia was made by cytologic examination. Based on the results from our study, there was 88.7% (220/248) agreement between cytologic and histologic diagnoses. In diagnosing neoplasia cytology had a sensitivity of 90.47%, a specificity of 97.22%, a positive predictive value of 98.44%, and a negative predictive value of 63.63%.     

Diagnosis of Kaposi's sarcoma by fine-needle aspiration biopsy

Fifteen cases of Kaposi's sarcoma diagnosed by fine-needle aspiration biopsy were reviewed. The diagnosis was confirmed by tissue biopsy in eight of the cases. All of the patients were homosexual males, and 13 had a previous diagnosis of AIDS. The aspirates were obtained from enlarged lymph nodes (five cases), soft-tissue masses (two cases), oral cavity lesions (seven cases), and an abdominal mass. The most characteristic cytologic features were intact tissue fragments composed of overlapping spindle cells with nuclear distortion and ill-defined cytoplasmic borders. Smaller groups of loosely cohesive spindle-shaped cells and individual spindle cells with cytoplasm were also helpful features. In the appropriate clinical setting, these cytologic features on FNAB are felt to be diagnostic of Kaposi's sarcoma.     

Light and electron microscopic examination of fine-needle aspirates in the preoperative diagnosis of cartilaginous tumors

Twenty-eight patients with chondrogenic tumours--2 chondroblastomas, 4 chondromas, 18 chondrosarcomas, 1 clear-cell chondrosarcoma, and 3 mesenchymal chondrosarcomas--underwent fine-needle aspiration biopsy (FNAB) in the preoperative investigation. The cytologic features in smears were compared with the histopathologic findings in the surgical specimens; in 14 cases they were also compared with the light and electron microscopic findings in resin-embedded fine-needle aspirates. The smears of the vast majority of the classical chondrosarcomas presented features that made possible the FNAB diagnosis of a chondrogenic tumor to be made. In the case of the low-grade chondrosarcomas in particular, which were poorly or moderately cellular in smears and showed chondroblastic cells often in lacunary structures of hyaline matrix, consideration of the clinical presentation, size, location, and roentgenographic appearance was essential for the diagnosis of chondrosarcoma. On the other hand, the high-grade chondrosarcomas presented cytologic features that clearly indicated their malignancy and they usually had a myxoid matrix. The possible differential diagnoses that may arise from the FNAB diagnosis of cartilaginous tumors are discussed. The resin-embedding technique for the light and electron microscopic examination of FNABs, along with the histochemical analysis for the demonstration of sulphated glucosaminoglycans and the immunocytochemistry applied to smears, was found to be of value in the definite diagnosis, especially in the distinction of chondrogenic tumors from chordoma and metastatic mucous-producing carcinoma.     

Accuracy of fine needle aspiration biopsy processed by cytologic smear and cell block techniques for the diagnosis of lacrimal gland tumors: a study of 48 cases

Objective: To study the accuracy of fine needle aspiration biopsy (FNAB) processed by smear cytology and cell block (CB) techniques for the diagnosis of lacrimal gland tumors (LGTs). Study Design: In a prospective study, we enrolled 48 consecutive patients with LGTs. Immediately after excision of LGTs, the tissues were underwent FNAB with 23-gauge needles. The FNAB samples were processed to produce cytologic smears and CB from which slides were cut for immunohistochemical staining. The remainders were submitted for routine histopathologic processing. The diagnostic value of FNAB was assessed by comparing the FNAB diagnoses to those made by routine histopathology. Results: Cytopathologic evaluations based on smear cytology and CB with sections stained immunohistochemically can distinguish non-epithelial lesions from epithelial ones in all cases. The diagnostic sensitivities, specificities, and accuracies for distinguishing benign from malignant lesions were: cytologic smears--76%, 68%, and 71%, respectively; CB with immunohistochemical staining--88%, 87%, and 88%, respectively. The accuracy of the tissue diagnosis compared to routine histopathology was less for cytologic smears (58%) than for CB with immunohistochemistry (81%; P < 0.05). Conclusions: FNAB of LGT processed using a CB technique capable of producing immunohistochemically stained slides results in a greater percentage of accurate tissue diagnoses than do cytologic smears, when compared to routine histopathology.     

Cytologic features of clear cell sarcoma (malignant melanoma) of soft parts: a study of fine-needle aspirates and exfoliative specimens

We describe the cytologic features of clear cell sarcoma of soft tissue (CCS) in 11 fine-needle aspiration biopsy (FNAB) specimens and 6 exfoliative specimens from 11 patients. In 3 patients, FNAB was the initial method of tumor evaluation. In 6 of 11 cases, immunostaining with S-100 or HMB-45 was evaluated. Electron microscopic evaluation was performed in 1 case. Both the FNAB and exfoliative specimens varied in overall cellularity, although reproducible cytologic features were identified. A significant diagnostic pitfall, namely the potential of CCS to form microacinar structures mimicking adenocarcinoma, is described with particular reference to CCS metastatic to regional lymph nodes. A rare case of the granular cell variant of CCS is illustrated as well. Owing to the rarity of CCS, the diagnosis on cytologic smears is extremely difficult and is aided substantially by pertinent clinical data. The diagnosis can be made conclusively by     

Comparative features of comedo and noncomedo ductal carcinoma in situ of the breast on fine-needle aspiration biopsy.

To determine whether fine-needle aspiration biopsy (FNAB) can differentiate between comedo (C-DCIS) and noncomedo ductal carcinoma in situ (NC-DCIS), we reviewed retrospectively the preoperative FNAB and surgical biopsy slides of 13 cases of DCIS with adequate cytologic material. Eight were NC-DCIS and 5 were C-DCIS. Three (60 percent) of the C-DCIS and 7 (88%) of the NC-DCIS were nonpalpable lesions biopsied under conventional mammographic guidance. Three (60%) of the C-DCIS but only 2 (25%) of the NC-DCIS were considered either suspicious or positive for malignancy on FNAB, the remainder in both groups being atypical. A statistically significant difference in marked nuclear pleomorphism (60% of C-DCIS vs. 0% of NC-DCIS, P = 0.04) and large nucleoli (60% of C-DCIS vs. 0% of NC-DCIS, P = 0.04) was observed between these 2 groups. DCIS is morphologically diverse, and it appears that the cytologic features of individual cells on FNAB may distinguish C-DCIS from NC-DCIS.