Small Cell Osteogenic Sarcoma of the Ribs: Cytological, Immunohistochemical, and Ultrastructural Study With Literature Review

Small cell osteosarcoma (OS) is a rare variant of OS that is composed of small cells resembling those of Ewing's sarcoma (ES) with recognizable osteoid. This type of tumor often creates difficulty in making a diagnosis when tissue samples do not include osteoid. The frequent sites are long bones and until now there have been no reported cases arising in the ribs. A case is reported here of small cell OS occurring in the ribs of a 37-year old female with its aspiration cytologic and electron microscopic characteristics. In the cytologic smear, the small round neoplastic cells were individually scattered or arranged in small nests. The nuclei were hyperchromatic and oval with no visible nucleoli. Ultrastructurally, the nuclei had a round or oval euchromatic chromatin pattern and occasional nucleoli. The scanty cytoplasm contained a small quantity of organelles including either tubular or dilated cisternae of RER, a few mitochondria, and free or polyribosomes. Other organelles were absent. Although the electron microscope sample of this case did not include bone mineral (hydroxy apatite), the electron microscopic features of the tumor cells were unique and useful for exclusion of other small round cell neoplasms.     

Clear cell lymphoma: a clinicopathological study of four cases

Four cases of clear cell lymphoma were studied by means of light and electron microscopy, enzyme-histochemistry, and E- and EAC-rosette formation. On light microscopic examination the tumors were seen to be composed mainly of round, oval, or slight irregular cells with water-clear, abundant cytoplasm. The neoplastic cells has round, oval, or convoluted nuclei with fine, evenly dispersed chromatin and one or more small but distinct nucleoli. On electron microscopic examination the clear cell lymphoma were characterized by lymphoid cells with striking electron lucent cytoplasm with few organelles. According to E-rosette test and enzyme-histochemical findings, the investigators proposed that the clear cell lymphoma may be derived from T-cell lineages. Differentiated diagnoses of clear cell lymphoma from B-immunoblastic sarcoma, pleomorphic cell lymphoma, clear cell sarcoma, and clear carcinomas derived from lung, ovary, or kidney were discussed.     

Glassy-Cell Carcinoma of the Cervix: Case Report with a Light and Electron Microscopy Study

A case of glassy-cell carcinoma of the cervix is reported. In the literature the tumor is regarded as an undifferentiated form of mixed carcinomas of the cervix. At the light microscopic level the tumor cells are characterized by a moderate amount of cytoplasm of ground-glass appearance that stains faintly blue with hematoxylin, a distinct cell wall that stains with eosin or with periodic acid-Schiff (PAS), and large vesiculated nuclei with prominent nucleoli. In the cytoplasm of very few tumor cells, a minute amount of Alcian blue-positive material is demonstrated. At the electron microscopic level the tumor cells show distinct cell borders with interdigitating cytoplasmic projections that contain many desmosomes. Cytoplasmic tonofilaments were demonstrated in few tumor cells. The nuclei show a euchromatic appearance with prominent mesh-basket nucleoli. The cytoplasm contains abundant ribosomes, polyribosomes, and round to oval mitochondria with transverse cristae. Some cells contain a prominent Golgi apparatus with many lysosomelike structures. A very few cells have small intracytoplasmic lumina with microvilli and annulate lamellae. The assumption that the glassy-cell carcinoma of the cervix represents a poorly differentiated adenosquamous carcinoma finds support from our ultrastructural study.     

Glassy-Cell Carcinoma of the Cervix: Case Report with a Light and Electron Microscopy Study

A case of glassy-cell carcinoma of the cervix is reported. In the literature the tumor is regarded as an undifferentiated form of mixed carcinomas of the cervix. At the light microscopic level the tumor cells are characterized by a moderate amount of cytoplasm of ground-glass appearance that stains faintly blue with hematoxylin, a distinct cell wall that stains with eosin or with periodic acid-Schiff (PAS), and large vesiculated nuclei with prominent nucleoli. In the cytoplasm of very few tumor cells, a minute amount of Alcian blue-positive material is demonstrated. At the electron microscopic level the tumor cells show distinct cell borders with interdigitating cytoplasmic projections that contain many desmosomes. Cytoplasmic tonofilaments were demonstrated in few tumor cells. The nuclei show a euchromatic appearance with prominent mesh-basket nucleoli. The cytoplasm contains abundant ribosomes, polyribosomes, and round to oval mitochondria with transverse cristae. Some cells contain a prominent Golgi apparatus with many lysosomelike structures. A very few cells have small intracytoplasmic lumina with microvilli and annulate lamellae. The assumption that the glassy-cell carcinoma of the cervix represents a poorly differentiated adenosquamous carcinoma finds support from our ultrastructural study.     

Retroperitoneal paraganglioma with multiple pulmonary metastases detected six years after complete resection of the primary tumor

Multiple pulmonary metastases from a retroperitoneal non-functional paraganglioma developed in a 69-year-old woman, who had been operated on for complete resection of a primary tumor about 6 years previously. An open-lung biopsy specimen revealed tumor cells possessing round or oval vesicular nuclei, numerous nucleoli and abundant, granular eosinophilic cytoplasm. Tumor cells showed small nests surrounded by distinct fibrovascular stroma. Upon electron microscopic examination, tumor cells were found to consist of chief cells that contained many mitochondria, a small number of dense-core granules and synapse-like structures. This case was worth reporting in order to emphasize the value of long-term follow-up, even after successful resection, and the usefulness of electron microscopic examination. This study was presented at the 25th Annual Meeting of the Clinical Electron Microscopy Society of Japan, Matsumoto, September 28–30, 1993.     

Fine-needle aspiration cytology of columnar-cell carcinoma of the thyroid: Report of two cases with cytohistologic correlation

The columnar-cell variant of papillary carcinoma is a rare tumor of the thyroid, associated with aggressive behavior, early visceral metastasis, and a rapidly fatal course. In this report we present the fine-needle aspiration cytologic findings of two examples of this variant of papillary carcinoma with cytohistologic correlation. In the smears, clusters, monolayered sheets, and scattered papillary fronds of tumor cells were present. The tumor cells were columnar and exhibited overlapping and stratification of the nuclei. In the first case the tumoral cells showed round nuclei with finely granular chromatin pattern, small nucleoli and vacuolated-appearing cytoplasm. The malignant cells in the second case presented oval to elongated nuclei with stippled chromatin, inconspicuous nucleoli and indistinct cytoplasmic borders. It is important to distinguish this tumor from the common thyroid papillary carcinoma because of its much more aggressive behavior. Diagn. Cytopathol. 1998;18:352–356. © 1998 Wiley-Liss, Inc.     

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.     

Scrape and fine-needle aspiration cytology of extraskeletal osteosarcoma

Extraskeletal osteosarcoma is a rare malignant soft tissue tumor whose cytologic findings are infrequently reported. We describe scrape and fine-needle aspiration biopsy (FNAB) cytology findings of an extraskeletal osteosarcoma in the right shoulder of a 24-yr-old man. Initial computed tomography revealed multiple ossification foci within the lesion. After excision of the primary tumor, the tumor recurred 13 months later. Scrape smears of both the primary tumor and FNAB smears of the recurrent tumor revealed moderate cellularity, cell clusters, and individual cells, closely associated with dense, homogeneous, acellular matrix material. The cells had elongated, oval, or partially bizarre-shaped nuclei with a coarse chromatin pattern and prominent nucleoli. The scrape smears contained large fragments of matrix material consistent with osteoid.     

Cytologic characteristics of congenital mesoblastic nephroma in fine-needle aspiration cytology: a case report.

The cytologic features of congenital mesoblastic nephroma (CMN) as recognized in smears of fine-needle aspirated cytology (FNAC) are reported. These included spindle- and tadpole-shaped cells with round to oval nuclei having small nucleoli and a smooth contour. The cytoplasm of these cells was dense and homogeneously stained. The background was composed of mucoid fibrillar material. The findings appear to be different from other types of renal tumors in infancy and specific enough for this tumor to allow diagnosis by FNAC.     

Fine-needle aspiration cytology of alveolar soft-part sarcoma

Alveolar soft-part sarcoma (ASPS) is a rare soft-tissue tumor. Few cases have been reported in the aspiration cytology literature. We discuss the fine-needle aspiration (FNA) cytologic features of ASPS in four patients. The smears were characterized by single cells and clusters of cells associated with thin-walled vasculature, resulting in a distinct pseudoalveolar pattern. The cells had abundant granular cytoplasm and large round nuclei with prominent central nucleoli. Binucleated and occasional multinucleated cells were present. Numerous stripped tumor nuclei were a consistent feature. Periodic acid-Schiff (PAS)-positive diastase-resistant granules were demonstrable within the intact and fragmented cytoplasm. Electron microscopy of aspirated material identified granules and crystals with the characteristic lattice pattern. To conclude, the FNA cytologic features of ASPS are characteristic. Confirmation by special stains and electron microscopy of FNA material is possible. The differential diagnostic considerations include renal cell carcinoma, paraganglioma, granular cell tumor, clear cell sarcoma, and epithelioid sarcoma.     

Fine-needle aspiration of intra-abdominal desmoplastic small cell tumor

The cytologic features of four cases of histologically confirmed intra-abdominal desmoplastic small cell tumor (DSCT) that occurred in males between 18-27 yr of age are presented. Smears showed small cells with scant cytoplasm which were primarily arranged in loosely cohesive clusters. Nuclei were oval to round with evenly distributed, finely granular chromatin and inconspicuous nucleoli. As is typical of DSCT, the cells strongly expressed keratin and desmin in all cases. In the one case studied by electron microscopy, it was demonstrated that the cells were joined by small junctions and contained paranuclear aggregates of intermediate filaments. The absence of the characteristic desmoplastic stroma in DSCT aspirates and the nonspecific cytologic features of this small round-cell tumor (SRCT) made cytologic interpretation difficult. Cytopathologists should be aware of this entity so that DSCT is included in the differential diagnosis of SRCTs that occur in intra-abdominal sites. A panel of markers that includes keratin and desmin should be used to assist in the identification of DSCT.     

Minimal deviation endometrioid adenocarcinoma of the cervix: report of three cases with exfoliative cytology

Three histologically confirmed minimal deviation endometrioid adenocarcinomas (MDEA) of the uterine cervix with cytologic evaluation by cervical scraping were reviewed. The smears were cellular and showed tall columnar tumor cells arranged in monolayered sheets with nuclei in palisade at free borders, rosettes, and irregular clusters. Cellular strips with palisading nuclei was noted in one case. The individual tumor cells showed monomorphic, round or oval, hyperchromatic nuclei with chromatin clumping, small nucleoli, and granular, nonvacuolated cytoplasm with cytoplasmic extensions or tails. The smear background showed a variable amount of necrotic debris admixed with polymorphonuclear leukocytes in two cases. The cytologic manifestations of those three cervical MDEAs overlapped, to some extents, with those of a cervical adenocarcinoma in situ and with those of a well-differentiated endometrial adenocarcinoma invading the cervix.     

Serous microcystic adenoma of the pancreas: cytologic and histologic features

Cytologic and histologic features in a case of serous microcystic adenoma of the pancreas in a 61-year-old female are presented. In fine-needle aspiration materials, epithelial cells arranged singly, in small clusters and in monolayer sheets were found. The neoplastic cells had round to oval nuclei with finely distributed chromatin and inconspicuous nucleoli. Nuclear atypia and mitoses were not seen. The cytoplasm was moderately abundant and finely granular. Histologically, the encapsulated tumor was composed of multiple small cysts lined by a single layer of flat to cuboidal cells. The tumor cells contained clear cytoplasm with glycogen and centrally located round to oval nuclei with inconspicuous nucleoli without any atypia. Mitoses were absent. The intervening stromal septa were hypocellular. Immunohistochemically, the tumor cells revealed diffuse positivity of cytokeratins and epithelial membrane antigen. Proliferative antigen Ki-67 was positive only in sporadic cells. No immunoreactivity for vimentin, carcinoembryonal antigen and S-100 protein was found. Chromogranin A and synaptophysin were expressed only in Langerhans' islets in the tumor capsula. In differential diagnosis, it is important to distinguish serous microcystic adenoma mainly from lymphangioma, cavernous hemangioma, serous cystadenocarcinoma, mucinous cystadenoma or cystadenocarcinoma, solid and pseudopapillary epithelial tumour, acinar cell cystadenocarcinoma, renal cell carcinoma and mesothelioma.     

Cytohistologic correlations in 56 synovial sarcomas in 36 patients: the Institut Curie experience

Synovial sarcoma (SS) is a high-grade malignant soft tissue tumor that manifests different phenotypic subtypes that may render their cytologic evaluation challenging. Although several cytologic studies of SS have been published, correlative studies of cytologic and corresponding histologic features are limited. To better define the cytological features of various SS forms, we reviewed the cytologic and the corresponding histologic material of 56 tumors from 36 patients. Classical patterns were defined as dispersed or small clusters of cells with bland chromatin, inconspicuous nucleoli, oval to spindle-shaped cytoplasm and branching tumor tissue fragments, vessel stalks, acinar structures in scant mucin background, seen in all 53 (94.7%) cellular cases. Epithelial, squamous, round cells, mast cells, necrosis, comma-like nuclei, marked nuclear atypia, secretory mucin, and rosette-like structures were also occasionally observed. Comparing the histological subtype we noted that epithelial cells and secretory mucin were restricted to biphasic SS, round cells to poorly differentiated SS, and comma-like nuclei to monophasic fibrous SS. We conclude that the classical pattern is highly suggestive of SS of all three monophasic, biphasic, or poorly differentiated subtypes. These characteristics, along with molecular genetic studies, may improve the cytologic diagnosis of SS.     

Imprint cytology of primary cardiac sarcomas: a report of 3 cases

Primary cardiac sarcomas are rare instances and only occasionally documented in the cytologic literature. Usually, the diagnosis of these rare lesions can be made at echocardiography, aspiration biopsy cytology, cardiac biopsy, and open cardiac surgery (intraoperative diagnosis). In this study, cytologic configurations and immunohistochemistry for 3 primary cardiac sarcomas (rhabdomyosarcoma, angiosarcoma, and malignant fibrous histiocytoma) were revealed. In rhabdomyosarcoma (right ventricle), the tumor cells exhibited an anisocytotic spindle-shaped nuclei with hyperchromasia and an obscure cytoplasmic margin. Vimentin and myosin were positive throughout the cytoplasm for the tumor cells. In angiosarcoma (right atrium), small clusters of anisocytotic spindle-shaped tumor cells appeared as vascular-like structures and hemosiderin-laden macrophages in many erythrocyte-rich backgrounds. Nuclei showed round to oval shape with hyperchromasia and prominent large nucleoli. Cytoplasm was obscure and elongated. Factor VIII related antigen and CD34 were strongly positive throughout the cytoplasm for the tumor cells. In malignant fibrous histiocytoma (right ventricle), the tumor cells exhibited oval to spindle-shaped and elongated nuclei and coarse granular chromatins with hyperchromasia. The nuclear margin was thin. A few small round nucleoli appeared. Elongated obscure and foamy cytoplasm was stained pale blue. Vimentin and α₁-antitrypsin were positive throughout the cytoplasm for the tumor cells. This study elucidated the cellular characteristics and immunohistochemistry for cardiac sarcomas using imprint smears as an aid to cytopathologic diagnosis.     

Fine-needle aspiration cytology of malignant retroperitoneal paraganglioma

The cytologic findings in a fine-needle aspiration sample are described from a large retroperitoneal mass in a 56-yr-old male. The aspiration was performed under CT guidance using a 22-gauge needle, maintaining negative pressure. For cytologic study, on-site smears were prepared and stained by the Papanicolaou method. Additionally, cytospin, filter preparations, cell blocks from the aspirate, histology, and electron microscopy of the tumor tissue were performed. Also, immunodiagnostic staining for neuron-specific enolase (NSE), chromogranin, S-100 protein, vimentin, HMB45, cytokeratin, and Grimelius preparation was performed on cytologic and histologic material. The cytologic material was characterized by cords, suggestive acinar structures, and small follicle-like clusters of cells, while cell blocks from the aspirate showed oval or spindle-shaped nuclei with a somewhat fasciculated appearance. However, sections from the tumor tissue showed an organoid “zellballen” pattern. The nuclei were round, oval, spindly, and epithelioid, with moderate to scanty cytoplasm, smooth nuclear membranes, fine, evenly dispersed chromatin, slight hyperchromasia, and mild pleomorphism. No intranuclear vacuoles were seen. Positive immunohistochemical staining for NSE, chromogranin, and Grimelius preparation was noted in the tumor cells, while staining for vimentin, HMB45, and cytokeratin was negative. Electron microscopy of the tumor tissue revealed the presence of variable numbers of round, membrane-bound, electron-dense neurosecretory granules. The cytohistologic and ultrastructural findings are presented, as well as the results of immunodiagnostic staining which helped in the diagnosis of retroperitoneal paraganglioma, an infrequently reported tumor. Diagn. Cytopathol. 1998;18:287–290. © 1998 Wiley-Liss, Inc.     

Cytopathology of malignant mesothelioma of the pleura in fine-needle aspiration biopsy

The cytologic findings in fine-needle aspiration biopsy (FNAB) of 9 histologically, immunohistochemically, and ultrastructurally confirmed malignant mesotheliomas of the pleura were reviewed. There were 4 epithelial malignant mesotheliomas (EMM), 3 sarcomatous mesotheliomas (SM), 1 mixed malignant mesothelioma (MMM), and 1 poorly differentiated malignant mesothelioma (PDMM). In FNAB, three EMMs yielded polygonal malignant cells with oval nuclei and prominent nucleoli, singly, in small sheets, and in tridimensional clusters with smooth or lobulated contours. In one EMM, only atypical mesothelial cells with prominent nucleoli were seen singly and in loose aggregates. In FNAB, two SM showed malignant spindle-shaped cells (MSC) with scant, ill-defined cytoplasm singly and in loose clusters. Cohesive clusters of elongated and polygonal cells with ill-defined, clear cytoplasm and pleomorphic nuclei containing small or prominent nucleoli were observed in one SM, with extensive clear-cell changes. In needle aspirates, the MMM showed polygonal malignant cells in clusters admixed with MSC. The PDMM displayed single and clustered large pleomorphic malignant cells, with prominent single or multiple nucleoli. Electron microscopic examination of minute tissue fragments retrieved from the FNAB in 2 cases of EMM revealed epithelial mesothelial cells with well-formed desmosomes and long slender microvilli (LSM) on the free tumor cell surfaces. In one case, LSM in direct contact with collagen fiber bundles in the tumor tissue matrix were observed, supporting the diagnosis of an invasive EMM. Diagn. Cytopathol. 1999;21:253-259.     

Cytologic features of ovarian granulosa cell tumors in pleural and ascitic fluids

Adult granulosa cell tumor (AGCT) is an uncommon neoplasm of the ovary with potential for aggressive behavior and late recurrence. The most important prognostic factor for AGCT is tumor stage. Thus, cytological assessment of pleural or ascitic fluids is crucial for initial staging and subsequent patient management. We report herein two cases of ovarian AGCT presenting with exfoliated tumor cells in pleural and ascitic fluid. The first case involved a 61‐year‐old woman who presented with stage Ic (a) AGCT. Seven years after initial diagnosis, pleural effusion and pleural dissemination were identified. The second case involved a 50‐year‐old woman who presented with stage IV AGCT with massive ascites and right pleural effusion. Fluid cytology from both cases showed cohesive or loose clusters of small uniform neoplastic cells with round‐to‐oval nuclei, coffee‐bean‐shaped nuclear grooves, small nucleoli, and scant cytoplasm. Call‐Exner bodies were also observed in these cytologic specimens. In the differential diagnosis of small monomorphic tumor cells in pleural effusion or ascites, coffee‐bean‐shaped nuclear grooves and cell clusters forming Call‐Exner bodies are diagnostic clues of AGCT. Diagn. Cytopathol. 2015;43:581–584. © 2015 Wiley Periodicals, Inc.     

Parachordoma/myoepithelioma of the kidney: first report of a myxoid mimicry in an unusual location

We report a case of parachordoma (or myoepithelioma) of the right upper kidney in a 56 year-old male patient. Light microscopic features of the tumor exhibited epithelioid, glomoid, and spindle cells with eosinophilic and vacuolated cytoplasm as well as round to oval nuclei. These cells were embedded in a myxoid and hyaline stroma separated by a fibrous tissue with minimal cellular atypia and a few small nucleoli. Immunohistochemically, the tumor cells were immunoreactive for epithelial membrane antigen, calponin, vimentin, S-100, and type-IV collagen. All kidney and adrenal were resected, and the patient was carefully followed up. During the 11 months follow-up, recurrence and metastases were not observed. To our knowledge, this study is the first to document a case of parachordoma/myoepithelioma of the kidney. We add this new case to existing tumors and discuss its distinction from other types.