Not by blood alone: Diagnosis of hemangiomas by fine-needle aspiration

Hemangiomas are common vascular neoplasms which are being radiographically detected and biopsied with increasing frequency during the workup of patients with malignant disease. The increasing confidence of radiologists in biopsying these lesions is in contrast to the reluctance of pathologists to make a specific diagnosis of hemangioma. Eleven cases of hemangioma, from both hepatic and superficial sites, were reviewed and the fine-needle aspirate findings discussed and illustrated. Three-dimensional arcades composed of bland elongated spindle cells or compact dense coils of spindle cells associated with scattered spindle-shaped cells were identified in 10 of 11 cases. In conclusion, recognition of the cellular pattern of hemangiomas combined with the radiologic information can enable a positive diagnosis of hemangioma to be made. Diagn. Cytopathol. 1998;19:250–254. © 1998 Wiley-Liss, Inc.     

Cytological features of malignant metastatic ameloblastoma: A case report and differential diagnosis

In this report, the cytological features and differential diagnosis of the metastasis from and subsequent local recurrence of an unusual case of malignant (metastatic) ameloblastoma are described, with histological confirmation. Characteristic cytological findings included fibrovascular central cores surrounded by palisading crowded basaloid or columnar cells or both and rosette-like structures of tumor cells with central fibrillary material. Keratin debris in the background and cystic cavities were prominent components of the metastatic ameloblastoma. The basaloid cells showed scant-to-absent cytoplasm, round-to-oval to tear-shaped nuclei, rare longitudinal nuclear grooves, single or multiple nucleoli, and smooth-to-clefted nuclear contours. No features to predict malignant behavior were identified (abundant mitotic activity, necrosis, nuclear pleomorphism). The cytological features of ameloblastoma appear to be characteristic enough to allow definitive diagnosis. However, since the cytology of this tumor is underreported in the literature, the unwary observer could easily misdiagnose it, especially at metastatic sites. Diagn. Cytopathol. 1998; 18:125–131. © 1998 Wiley-Liss, Inc.     

Giant-cell tumor in soft parts in a patient with osseous Paget's disease: Diagnosis by fine-needle aspiration

In this report, the cytological features and differential diagnosis of a case of giant-cell tumor (GCT) in soft tissues in a patient with osseous Paget's disease (PD) are described, with histological confirmation. Characteristic cytological findings include a diffuse cellular population of neoplastic cells composed of two types: one group of polygonal or round mononuclear small cells, exhibiting a thin-rim, dense cytoplasm and single hyperchromatic nuclei; and the second group of multinucleated, osteoclast-type giant cells with dozens of round nuclei, showing occasional micronucleoli. A prominent feature is the presence of numerous capillary structures surrounded by tumor cells. The differential diagnosis includes a number of other neoplastic and reactive processes in which giant cells may be abundant. The cytological features of GCT appear to be characteristic enough to allow a suggestive diagnosis. However, the final diagnosis should be made only after the lesion has been studied histologically. Diagn. Cytopathol. 1998;19:352–354. © 1998 Wiley-Liss, Inc.     

Negative images due to MAI infection detected in Papanicolaou-stained duodenal brushing cytology

Atypical mycobacteriosis of the duodenum was diagnosed by duodenal brush cytology in a woman with AIDS. Smears were fixed in alcohol and stained by the method of Papanicolaou. The cytological characteristics of this disease have been described previously in other cytological specimens such as imprints or fine-needle aspirations stained with Diff-Quik or Wright's stain. We found that alcohol fixation and routine Papanicolaou staining allow observation of numerous foamy and striated macrophages (pseudo-Gaucher cells), as well as negative images both within the cytoplasm of the macrophages and in the background of smears in areas of air-drying artifact. These findings should suggest the diagnosis of atypical mycobacteriosis, and special staining techniques such as PAS and Ziehl-Neelsen are useful in corroborating it. This has not been previously described. Diagn. Cytopathol. 1998;19:462–464. © 1998 Wiley-Liss, Inc.     

Skeletal metastases from a granulosa-cell tumor of the ovary: Report of a case diagnosed by fine-needle aspiration cytology

We report on the fine-needle aspiration cytological findings of a metastatic granulosa-cell tumor of the ovary to bone. The patient had undergone resection of a primary ovarian granulosa-cell tumor 15 yr prior to her last admission. Recently she injured her right hip, sustained after a fall. CT examination revealed hypodense lesions involving the posterior body and the right pedicle of the L1 vertebra. The aspirate from the bone yielded a highly cellular smear, composed of round to oval cells with scanty cytoplasm. Many of the cells revealed the presence of nuclear grooves. In areas, the cells were arranged in clusters resembling Call-Exner bodies. The rarity of skeletal metastases from granulosa-cell tumors can cause diagnostic difficulty in diagnosing this entity. Accurate clinical data, radiological findings, and cytological features are important in arriving at the correct diagnosis. Diagn. Cytopathol. 1998;19:375–377. © 1998 Wiley-Liss, Inc.     

Epithelioid hemangioma: morphological presentation on aspiration smears

Epithelioid hemangioma (EH) or angiolymphoid hyperplasia with eosinophilia is an uncommon but distinctive lesion seen principally in the skin and subcutaneous tissue. The histopathology of this disease is very characteristic, but error in diagnosis is possible on cytopathology. There are very few case reports describing the cytomorphology of this lesion. We describe the findings of fine-needle aspiration of two cases of EH both arising in the subcutaneous tissue of the head and neck. Both the cases were misdiagnosed on cytology with one case being misinterpreted for an epithelioid sarcoma and the other for a reactive lymph node. The cytological findings of these cases are described and the problems encountered in the diagnosis of this entity are highlighted in this case report.     

Fine-needle aspiration of testicular lesions: report of 17 cases

In this article we report on our diagnostic experience of fine-needle aspiration biopsies (FNAB) performed on 17 patients with testicular lesions in the period from 1994-1998. The cytological diagnosis was consistent with seminoma in 7 cases, sex cord-stromal tumors in 3 cases (2 Sertoli cell tumors, 1 Leydig cell tumor), embryonal carcinoma in 3 cases, and yolk-sac tumor in 1 case; the other 3 patients were suffering from flogistic pathology. The cytological diagnosis was confirmed in all cases after surgery. According to our experience, ultrasound FNAB of testicular lesions proved to be a very reliable technique in predicting malignancy with high sensitivity and specificity. None of the patients developed local recurrences or inguinal lymph-node metastasis due to FNAB. Therefore, tumor stage classification (TNM) was not modified in any patient.     

p53、p63及p73在皮肤血管瘤组织中的表达

目的　为探讨p5 3p6 3及p73蛋白在皮肤血管瘤组织中的表达及意义。方法　采用免疫组织化学S P法和图像分析技术检测 4 0例血管瘤组织和 2 0例正常皮肤组织中p5 3、p6 3及p73基因的表达。结果　在增生期血管瘤、退化期血管瘤和正常皮肤组之间 ,p73蛋白免疫组化阳性反应颗粒的平均光密度分别为 6 4 0 8± 2 15 1、1 0 73± 0 5 16和 0 95 3± 0 12 0。p6 3蛋白免疫组化阳性反应颗粒的平均光密度分别为 8 2 71± 1 95 3、0 92 3± 0 191和 0 92 0± 0 187。p5 3蛋白免疫组化阳性反应颗粒的平均光密度分别为 7 2 4 0± 1 874、0 934± 0 187和 0 92 3± 0 16 5。增生期血管瘤与退化期血管瘤、正常皮肤组分别组比 ,p73、p6 3及p5 3阳性表达的差异均有高度显著性差异 (P <0 0 0 1) ,消退期血管瘤与正常皮肤组之间 ,p73、p6 3及p5 3阳性表达差异无显著性 (P >0 0 5 )。结论　在增生期血管瘤组织中p73、p6 3及p5 3呈高表达 ,促进了内皮细胞的增殖 ,是导致血管瘤发生、发展的主要因素     

Fine-needle aspiration of thyroid tumors: identifying factors associated with adequacy rate in a large academic center in the Netherlands

The goal of our study was to evaluate, and identify factors associated with, the adequacy rate of fine-needle aspiration (FNA) cytology of thyroid tumors to improve the quality of the procedure. We reviewed 1,611 cytological pathology reports of thyroid tumors of 871 patients between January 1998 and August 2008. The overall cytological adequacy rate was 53.9%. The freehand technique had significantly higher adequacy rates than the ultrasound (US)-guided technique (P < 0.001) regardless of size, tumor type, multinodularity, or location. Aspiration, performing specialist (endocrinologist versus radiologist), and size were the factors associated with adequacy rates. US-guided FNA is recommended in previous articles, but results in our clinic were in favor of freehand FNA. US guidance is a way to improve adequacy rates, but we would like to stress the importance of other factors like operator experience, education, and quality control in one's own institution before implementing techniques.     

Psammomatous melanotic Schwannoma localized in the mediastinum: diagnosis by fine-needle aspiration cytology

The cytological characteristics are presented in a case of psammomatous melanotic schwannoma localized in the mediastinum, diagnosed by fine-needle aspiration cytology (FNAC), with later histological confirmation. This lesion affected a 38-year-old male, with a tumor measuring 5 cm in diameter located in the posterior mediastinum in contact with the spinal cord, with erosion of the adjacent vertebra (T5), that caused constant pain localized in the right scapular region with an evolution of several weeks. The cytological characteristics of psammomatous melanotic schwannoma are discussed, along with the histological and immunohistochemical features of this infrequent neural tumor, which aid in establishing a differential diagnosis. The importance of a correct histological diagnosis of this tumor is of particular clinical relevance after having been identified as one of the possible components of Carney's complex. This possibility demands a meticulous patient exploration in search of any other components that make up this complex, given the aggressive character of some of them. These lesions could, if not detected early enough, produce fatal consequences for the patient, fundamentally in those patients with cardiac myxomas. In this case, following an exhaustive clinical examination there was no pathology associated with this complex. It is therefore considered to be an isolated psammomatous melanotic schwannoma, and not a part of Carney's complex. Diagn. Cytopathol. 1998;19:298–302. © 1998 Wiley-Liss, Inc.     

Elevated IGF2 prevents leptin induction and terminal adipocyte differentiation in hemangioma stem cells

Infantile hemangioma is a benign vascular tumor that exhibits a unique yet predictable lifecycle of rapid proliferation followed by spontaneous regression. Recent studies have identified that insulin-like growth factor-2 (IGF2), a fetal mitogen, is highly expressed during the proliferative phase of hemangioma growth. Since hemangiomas arise from CD133 + stem cells, high levels of IGF2 may regulate the activity of the stem cells and therefore, hemangioma growth. The aim of this study was to understand the functional significance of elevated IGF2 in hemangiomas. We show that IGF2 localizes to the CD133 + cells in hemangioma specimens. We, therefore, hypothesized that IGF2 may be regulating the plasticity of hemangioma stem cells. To test our hypothesis, we used CD133-selected cells from hemangiomas to knockdown the expression of IGF2. We found that IGF2 is a mitogen for hemangioma stem cells and prevents leptin induction and full terminal differentiation of hemangioma stem cells into adipocytes. We also show that IGF2 does not alter the initial commitment phase. These findings implicate an important role of IGF2 in expanding hemangioma stem cells and preventing terminal adipocyte differentiation.     

Cytologic features of sclerosing hemangioma of the lung on crush preparations

Sclerosing hemangioma of the lung is a rare benign neoplasm. The majority of the literature published on sclerosing hemangioma has focused on the histologic features, while only a few case reports have described the cytologic features. We report two additional cases of sclerosing hemangioma of the lung in which the cytologic material was prepared at the time of frozen section. Because of the rarity of this lesion and the overlapping cytologic features with other primary malignant lung tumors, awareness of the cytologic features of sclerosing hemangioma may help to avoid a diagnosis of malignancy. This is especially true pre‐ and intraoperatively because a limited resection may suffice if a diagnosis of sclerosing hemangioma can be established. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

Parathyroid Hemangioma: A Report of Two Cases

Two cases of intraparathyroid hemangioma, associated with hyperparathyroidism, are reported. The first case showed a typical capillary hemangioma morphology with small branching vascular channels, almost completely replacing the gland’s architecture. The second case was a 2-mm cavernous hemangioma associated with glandular hyperplasia. This is, to our knowledge, the first time that this type of lesion is described.     

Bax和Fas在人皮肤血管瘤不同时期的表达及意义

目的　探讨Bax和Fax在血管瘤发生、发展及退化过程中的作用。方法　采用免疫组织化学方法 (S P法 )检测4 9例人皮肤血管瘤增生期、退化期及正常组织中Bax和Fax的表达水平。结果　发现Bax和Fas在血管瘤退化期的表达高于增生期 ,差异有显著性 (P <0 0 1)。结论　Bax和Fas与血管瘤的自然退化密切相关。     

胆囊切除的术中探查

目的 讨论胆囊切除术术中探查的意义。方法 随机抽１９９５～１９９８年间我院行单纯胆囊切除术的临床资料。结果 术中探查发现胆囊癌Ⅴ期１例，胆囊内无结石２例，胆总管探查阴性３例，胰腺头部结石１例，Ｍｉｒｒｉｚｉ综合征１例，合并肝内胆管结石２例，肝海绵状血管瘤１例。术前均未明确诊断。结论 胆囊切除术术中探查具有重要意义。     

Conversion of a neonatal hepatic hemangioma to focal nodular hyperplasia

Hepatic hemangioma and focal nodular hyperplasia are both frequently observed benign lesions of the liver. Whereas hepatic hemangioma is the most frequent benign liver tumor in children, focal nodular hyperplasia occurs predominantly in adult patients. Concomitance of both entities has been described in adults, suggesting a similar pathogenesis. We report on a 6-month-old child with a continuously shrinking hepatic hemangioma after interventional therapy and a growing hepatic mass 5 years later, which emerged as focal nodular hyperplasia at the site of the former hemangioma. Diagnostic and therapeutic strategies regarding this patient are discussed. The present case supports the theory that these two entities may share a similar pathomechanism.     

Fine needle aspiration biopsy of epithelioid hemangioendothelioma of the oral cavity: report of one case and review of literature

Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor with biological behavior intermediate between hemangioma and angiosarcoma. It rarely occurs in the oral cavity. We report a case of an 81-yr-old woman with a 2-mo history of a 2 x 2 cm2 submucosal buccal mass. Fine needle aspiration (FNA) smears were paucicellular and showed mainly single atypical large epithelioid cells in a bloody background. The atypical cells had abundant dense cytoplasm, some with fine vacuoles. Occasionally, cells with large cytoplasmic lumina were seen. Cytology preparations from fresh tissue received for frozen section revealed numerous neoplastic cells with large intracytoplasmic lumina, some of which contained red blood cells. In addition, cells with distinct intranuclear inclusions were present. Histologic sections and immunohistochemical stains confirmed the diagnosis of EHE. Although the histologic features of EHE are well recognized, reports of FNA cytology findings are sparsely existent in the literature as several case reports. The characteristic cytological features of EHE are reviewed in this report. We believe that the diagnosis of this rare tumor can be suggested when an adequate FNA specimen is obtained.