Fine needle aspiration cytology of metastatic dermatofibrosarcoma protuberans. A case report

Report is made of the fine needle aspiration (FNA) cytologic detection of a rare pulmonary metastasis of dermatofibrosarcoma protuberans, a locally aggressive tumor with a low metastatic potential but a high propensity for recurrences. The cytologic findings paralleled those seen on tissue sections and were characterized by tissue fragments displaying a storiform pattern and slender, spindle-shaped cells. Histiocytic differentiation and mitotic figures were also detected in the cytologic preparations. It is concluded that metastatic dermatofibrosarcoma may be accurately diagnosed by FNA cytology.     

Fine needle aspiration cytology of dermatofibrosarcoma protuberans presenting as a breast mass. A case report

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous soft tissue neoplasm with a tendency to recur but rarely metastasize. It occurs at almost any site but usually in the trunk and extremities. DFSP mimicking a primary breast lesion has not been reported before. CASE: A 30-year-old female presented with an eight-month history of a breast mass that was aspirated, revealing a spindle cell neoplasm. The diagnosis of DFSP was made on excisional biopsy. CONCLUSION: The diagnosis of DFSP may be problematic, especially when it presents clinically as a primary breast lesion.     

Cryotherapy for local recurrent dermatofibrosarcoma protuberans: Experience in 19 patients

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, cutaneous, malignant tumor characterized by a high propensity for local relapse. Wide and deep local excision with reconstructive surgery is the current standard therapy for DFSP, with a local recurrence rate (LRR) of nearly 40%. In this study, we cured 19 patients with local recurrence of DFSP with 39 sessions of percutaneous cryoablation performed between July 2004 and August 2008. The LRRs after one, two and three cryosurgery sessions per patient were 68%, 54% and 0%, respectively. Moreover, the LRR did not differ with tumor location or size. Furthermore, all patients had a progression-free survival of >5 years. Only minor complications such as fever, local edema, mild nerve injury and local pain occurred, and were resolved within 1 week with symptomatic treatment. In our experience, percutaneous cryoablation is a relatively safe and efficient technique for the treatment of local recurrence of DFSPs.     

Aspiration cytology of fibrosarcomatous variant of dermatofibrosarcoma protuberans with osteoclastlike giant cells in the chest wall: a case report

BACKGROUND: A case of fibrosarcomatous variant of dermatofibrosarcoma protuberans (FS-DFSP) with osteoclastlike giant cells involved the dermis and subcutaneous tissue of the chest wall. This case was misdiagnosed as primary breast tumor clinically and had cytologic features similar to those of the metaplastic breast carcinoma (MRBC). CASE: A 53-year-old female presented with a nodular breast mass enlarging slowly over a long period of time and growing rapidly for about 3 months. The aspirates showed high cellularity with both individually scattered and fascicular arrays of spindle cells. A few multinucleated giant cells without nuclear atypia were intermixed with dissociated spindle cells. There was no epithelial component in the smear. Cytologic evaluation suggested the possibility of a low grade spindle cell sarcoma as well as MBC. Subsequently, the patient underwent modified radical mastectomy, and the diagnosis of FS-DFSP was made. CONCLUSION: Distinguishing FS-DFSP with osteoclastlike giant cells from other spindle cell tumors of the breast, especially MBC showing predominantly spindle cell components, may pose significant challenges to the pathologist. However, clinical and radiologic findings and a meticulous search for other components raised the possibility of FS-DFSP on aspiration cytology.     

Role of FNAC in metastasizing malignant mixed tumor of the external auditory canal. A case report

BACKGROUND: No previous report of metastasizing mixed tumor (pleomorphic adenoma) of the external auditory canal (EAC) has been described. CASE: A 12-year-old, Chinese girl with a history of mixed tumor of the EAC presented with a locally recurrent, aggressive tumor and metastases to the lung and bone five years later. The primary, locally recurrent and metastatic lung tumor showed epithelial and myoepithelial elements with duct formation, chondromyxoid stroma and mitotic activity in the cellular areas on histology. Fine needle aspiration cytology (FNAC) disclosed the presence of spindle cells blending into chondromyxoid fibrillar ground substance in the recurrent and metastatic lung tumors. CONCLUSION: In primary mixed tumor of the EAC, FNAC plays a useful role in the diagnosis of recurrent and metastatic disease. Its ability to identify ominous features, such as increased mitoses in this case, may be limited by sampling. Since cytology and histology cannot reliably prognosticate, long-term follow up of mixed tumor of the EAC after complete excision is advocated.     

Cytology of recurrent ameloblastoma with malignant change. A case report

BACKGROUND: Ameloblastoma is a rare tumor of the jaw that arises from the odontogenic epithelium. Ameloblastomas have a propensity for local recurrence and, rarely, for metastasis. The term malignant ameloblastoma is reserved for those metastasizing tumors that retain the typical morphology of ameloblastoma. Fine needle aspiration (FNA) reports on ameloblastomas are scant, and those on malignant ameloblastomas are still more so. CASE: In a case of malignant ameloblastoma diagnosed by FNA cytology, the clinical presentation was that of a malignant neoplasm. FNA smears were highly cellular and showed isolated, scattered cells and small groups of basaloid cells and polygonal squamous epithelial cells. Stellate and spindle-shaped cells were also seen in the background. The cytologic diagnosis was subsequently confirmed on histopathology. CONCLUSION: The characteristic combination of cells in FNA smears facilitated the diagnosis of ameloblastoma. Since the biologic behavior of the tumor was that of a malignant neoplasm, the slides were reviewed. The cytologic smears did not exhibit sufficient features of malignancy to label the lesion malignant.     

Giant basal cell carcinoma of the forehead: a case report

Giant basal cell carcinoma (GBCC) is defined as a tumor 5cm or greater in diameter. They present less than 1% of all basal cell carcinomas. We present a case of an 85-year-old male patient with a giant ulcerating tumor of the left forehead (measuring 7x6 cm). Under local anesthesia tumor was surgically excised. No involvement of the underlying periostal or bone structure was noted. Pathohystological exam revealed the giant basal cell carcinoma, with free surgical margins. Giant basal cell carcinomas are rare tumors and are usually result of a long duration and patient neglect. In comparison to the ordinary basal cell carcinoma these tumors have a higher metastatic potential. Surgical resection with negative surgical margin is the best possible treatment option.     

Cytologic diagnosis of florid peritoneal endosalpingiosis. A case report

The cytologic findings in a case of endosalpingiosis presenting in peritoneal washings taken at the time of staging laparotomy for endocervical adenocarcinoma are described. Dense papillary epithelial clusters with distinct ciliated cell borders were found in the cytologic specimens. Cell nuclei were oval, with finely dispersed chromatin and uniform nuclear membranes. These findings, in conjunction with the discovery of tubal-type epithelial inclusions in pelvic and periaortic lymph nodes, established a diagnosis of endosalpingiosis or benign glandular inclusions involving the pelvic peritoneum and lymph nodes.     

Fine needle aspiration diagnosis of lymphangiomyomatosis. A case report

BACKGROUND: Lymphangiomyomatosis is a rare disease of females, usually of reproductive age. There is a proliferation of lymphatic smooth muscle in mediastinal, retroperitoneal and often pulmonary lymphatics and lymph nodes. CASE: A 45-year-old female presented with a right pleural effusion and increasing retroperitoneal adenopathy with palpable left inguinal adenopathy. Three months previously she had undergone a right salpingo-oophrectomy for an ovarian fibroma with concomitant left ovarian wedge biopsy, myomectomy for leiomyomas and partial omentectomy. Three years previously, at age 42, she had experienced two transient episodes of chylous pleural effusion with no sequelae. She underwent computed tomography-guided fine needle aspiration of a 4-cm inguinal lymph node to rule out lymphoma. CONCLUSION: Fine needle aspiration of lymphangiomyomatosis yields distinctive cytologic morphology. This characteristic morphology, in combination with the appropriate history, permits a minimally invasive, timely and in this particular case, entirely unexpected diagnosis.     

Intraoperative cytologic diagnosis of chordoid meningioma. A case report

BACKGROUND: Chordoid meningioma is an uncommon supratentorial tumor in which a cordonal pattern on a mucofibrillar background covers areas of classic meningioma with a diffuse, meningeal, immunohistochemically reactive pattern. Its cytology has not been described before. CASE: A 45-year-old woman with headaches and a poorly defined, nondiplopic vision alteration underwent magnetic resonance imaging, which showed a tumor in the upper part of the left orbital cavity. An intraoperative squash smear showed closely knit, pseudosyncytial plates composed of medium-sized cells with homogeneous nuclei and nuclear pseudoinclusions. There were some physaliferouslike, loose cells without cytoplasmic vacuolation and a fairly abundant, metachromatic, pink to light purple background that was absent inside the plates. A diagnosis of meningioma with a possible chordoid pattern was made. No frozen intraoperative section was prepared. Histology showed 90% chordoid meningioma merging with areas of classic meningothelial meningioma and overall positivity for epithelial membrane antigen and vimentin. S-100 was negative. CONCLUSION: A reliable intraoperative cytologic diagnosis of chordoid meningioma can be made because the morphology is highly characteristic. Close cellular association and the cells' nuclear traits are expected in a meningioma. The metachromatic background can cause a false diagnosis of chordoma. However, there are some clear differences in the cells and their relation to the mucofibrillar matrix that make the diagnosis definitive.     

Endovascular gamma-irradiation to prevent recurrent femoral in-stent restenosis. A case report

We report about a patient with twice recurrence of femoral in-stent restenoses. Centered endoluminal gamma-irradiation with 192 iridium was performed immediately after the second stent recanalization. The irradiation dose was 14 Gy calculated at 2-mm depth of vessel wall. One-year follow-up demonstrates neither clinical nor angiographic evidence of restenosis.     

Fine needle aspiration diagnosis of lymphomatoid granulomatosis. A case report.

The diagnosis of lymphomatoid granulomatosis (LG) of the lung depends on obtaining adequate histologic material to demonstrate the characteristic angioinvasive, polymorphous, lymphoid infiltrate and normally requires an open lung biopsy. Fine needle aspiration biopsy (FNAB), if only smeared directly, does not allow an assessment of the lymphoid infiltrate in relation to blood vessels. However, we report a case diagnosed by FNAB in which the specimen was processed by an alternative method that allows cell blocks to be made from all visible particles. Percutaneous FNAB of a nodular pulmonary infiltrate was performed after bronchoscopy and transbronchial needle biopsy failed to yield a diagnosis. The FNAB specimen was placed in 50% alcohol and submitted for processing. The specimen was then filtered through a fine sieve, and all visible tissue was embedded in bacteriologic agar and processed as a standard surgical specimen. The filtrate was processed as standard fluid cytology. The atypical, angioinvasive, lymphoid infiltrate was clearly demonstrated on the cell blocks, and the diagnosis of LG was made. This diagnosis was confirmed by subsequent open lung and skin biopsies.     

Cytologic diagnosis of schistosomiasis in routine urinary specimens. A case report

A voided urine specimen from a 29-year-old male living in New York was sent for cytologic study, which revealed five schistosome ova, two with terminal spines, and one free miracidium in a cytocentrifuge specimen. The patient, who had been in West Africa three years earlier, underwent cystoscopy, with the finding of bladder mucosal ulcerations. Subsequent cytologic specimens, bladder biopsy and wet-mount preparations established a diagnosis of Schistosoma haematobium infection, which was treated, apparently successfully, with Metrifonate. The case is presented to focus attention on the cytologic diagnosis of S. haematobium in routine urinary specimens since the opportunity to make such a diagnosis is increasing in the continental United States as more Americans visit areas of endemic infestation and more residents of those areas immigrate to this country.     

Cytologic diagnosis of primary adenocarcinoma of Bartholin's gland. A case report.

The cytologic and histologic findings in an extremely rare case of adenocarcinoma of Bartholin's gland are described. The tumor cells in scraping and fine needle aspiration smears were in clusters. The nuclei were oval to oblong, and some cells had a peripherally displaced nucleus. The chromatinic material was slightly increased, and some nuclei had prominent nucleoli. The cytoplasm was basophilic and abundant. Microcalcifications and psammoma bodies were numerous. The tentative diagnosis was primary adenocarcinoma of Bartholin's gland, based on the cytologic findings and location of the tumor. Similar findings were noted in the biopsy and surgical specimens.