Colloid carcinoma of the breast with concomitant metastasis and a tuberculous lesion in the axillary lymph nodes. A case report.

A 30-year-old woman presented with a lump in the left breast and left axillary lymphadenopathy that, on fine needle aspiration cytology (FNAC), proved to be duct cell carcinoma with metastasis. Histology of the radical mastectomy specimen showed a mixed colloid carcinoma. Axillary lymph nodes revealed a variety of pathologic changes consisting of reactive hyperplasia, tuberculosis and metastasis. A combination of a tuberculous lesion and metastasis in the same lymph nodes was also found. During follow-up, after radiotherapy, the patient developed left supraclavicular and right cervical lymphadenopathy that, on FNAC, revealed a tuberculous lesion and metastasis, respectively. The rarity of this condition with double pathology is highlighted, and the reason behind the limitations of FNA in subtyping the primary malignancy and its failure to detect the tuberculous lesion in the axillary lymph node are discussed.     

Inflammatory myofibroblastic tumor of the breast. A case report

BACKGROUND: Inflammatory myofibroblastic tumor (IMT) of the breast is a very rare tumor like lesion with only 6 previously reported cases. Very little is known about the cytology of IMT. We present the fine needle aspiration (FNA) cytology of a case of recurrent, bilateral IMT of the breast and detail the clinical course, radiologic findings, morphologic appearances and immunohistochemical profile of the lesion. CASE: A 79-year-old female was initially seen in 1991 because of a suspicious mammographic abnormality in her right breast. Ultrasound-guided FNA cytology showed an unusual "inflammatory" lesion with occasional aggregates of cellular connective tissue fragments, sheets of uniform ductal epithelial cells with myoepithelial cells, spindle cells, lymphocytes and histiocytelike cells. The lesion was excised, and histology confirmed a benign process with spindle cells, lymphocytes and histiocytes. No malignant features were noted. During follow-up many new lesions appeared in both breasts, and after several FNA procedures and local excisions, bilateral mastectomy was performed at the patient's urging. She remained disease free. CONCLUSION: Although IMT of the breast has benign cytology and histology, clinically and on imaging, it resembles carcinoma. Awareness of the condition may help prevent a false diagnosis of carcinoma.     

Oral leiomyosarcoma in childhood. Report of a case with fine needle aspiration cytology

BACKGROUND: Leiomyosarcomas are rare tumors in the pediatric age group, and occurrence of this neoplasm in the oral cavity is exceedingly rare. This article highlights the fine needle aspiration (FNA) cytology diagnosis of a case of recurrent oral leiomyosarcoma in childhood. CASE: An 11-year-old male noticed a swelling in the oral cavity near the left lower jaw. It was excised and diagnosed as leiomyosarcoma on histopathology. Four months later the patient presented with a progressive swelling in the oral cavity that extended to the lower jaw. The recurrent swelling was subjected to FNA, and its cytologic features were consistent with leiomyosarcoma. There was a very good initial response to chemotherapy and radiation therapy. However, because of noncompliance with advice for further therapy, the patient had a second local recurrence and dissemination of the disease to the skeletal system, abdomen and thorax. FNA cytology diagnosis of the second locally recurrent lesion and abdominal mass were consistent with leiomyosarcoma. Immunocytochemical staining revealed a positive reaction in the cytoplasm of tumor cells for vimentin and desmin in the FNA smear and paraffin section, respectively. CONCLUSION: Fine needle aspiration cytology is a useful technique for detection of recurrence and metastasis during follow-up of childhood oral leiomyosarcoma.     

Fine needle aspiration diagnosis of osteitis fibrosa cystica (brown tumor of bone): a case report

BACKGROUND: Fine needle aspiration (FNA) cytologic diagnosis of bone lesions is controversial; opponents cite its low sensitivity and proponents emphasize its cost-effectiveness, specificity and rapid turnaround time. The focus of FNA cytology is most often to exclude malignancy, which may contribute to incomplete information sharing on the part of the health care team and the published low sensitivity of diagnostic cytology of osseous lesions. It is therefore incumbent upon cytopathologists to formulate a complete differential diagnosis of osseous lesions. CASE: A 72-year-old man, admitted for severe abdominal pain, underwent diagnostic computed tomography (CT) examination that incidentally revealed multiple abdominal and pelvic lytic bone lesions. CT-guided FNA of a lesion revealed bland histiocytic and spindled cells, prominent hemosiderin pigment and scattered multinucleated cells, findings consistent with osteitis fibrosa cystica. Subsequent consultation with the medical team revealed the patient's underlying secondary hyperparathyroidism. CONCLUSION: This case emphasizes the importance of correlating clinical history and radiologic findings to the accurate cytologic diagnosis of bone lesions. The benign cytomorphologic features of brown tumor should not be overlooked or be considered nondiagnostic in the hunt for suspected malignancy. FNA allowed confident exclusion of a malignant process and prevented unnecessary surgery and its inherent risks.     

Cementifying fibroma diagnosed by fine needle aspiration cytology. A case report.

A case of cementifying fibroma in the right lateral mandible was diagnosed by fine needle aspiration (FNA) cytology. The aspirate was a cellular specimen composed of clusters of oval and spindle-shaped fibroblasts with no atypical features. These cells were admixed with spherical, calcified structures. A diagnosis of "consistent with benign fibroosseous lesion, suggestive of cementoossifying fibroma" was made, and subsequent histologic examination confirmed this cytologic diagnosis. The clinical, cytologic and histologic findings in the case are presented, and the value of FNA cytology in the diagnosis of jaw lesions is discussed.     

Hepatic actinomycosis diagnosed by fine needle aspiration. A case report

A 43-year-old woman, a long-term intrauterine contraceptive device (IUD) wearer with a history of Actinomyces organisms seen in cervicovaginal smears, developed hepatic actinomycosis 13 months after removal of the IUD. The liver involvement was diagnosed by fine needle aspiration (FNA) cytology and the use of immunocytochemical techniques. Histopathologic examination of a right pelvic mass removed at surgical exploration revealed an Actinomyces tuboovarian abscess, the primary lesion in this case. The importance of cytologic detection of Actinomyces in cervicovaginal smears for the prevention of IUD-related pelvic inflammatory disease (PID) is discussed, as is the usefulness of FNA cytology in the diagnosis of systemic actinomycosis.     

Focal adenomatoid hyperplasia of salivary glands. A differential diagnostic problem in fine needle aspiration biopsy

Adenomatoid hyperplasia of minor salivary glands is an idiopathic lesion usually involving the palate and mimicking a primary salivary gland neoplasm. In particular, the lesions may resemble low-grade mucoepidermoid tumors clinically and by fine needle aspiration (FNA) cytology. An illustrative case is presented, and the nature of this unusual entity is reviewed. Its importance in the differential diagnosis of FNA biopsies of minor salivary gland lesions is also discussed.     

Fine needle aspiration cytology of primary bone lesions

Fine needle aspiration (FNA) cytologic findings were compared with the results of conventional histology in a series of primary bone lesions to determine the diagnostic accuracy of FNA cytology. The series included 12 osteogenic sarcomas, 4 Ewing's sarcomas, 3 chordomas, 3 myelomas, 2 chondrosarcomas, 2 undifferentiated sarcomas and 1 case each of normal bone and marrow elements, lymphoma and giant-cell tumor. All aspirates yielded adequate material for smear diagnosis, and all 29 cases were correctly identified as benign or malignant by cytology. In 19 cases (66%), specific cytologic diagnoses were rendered and histologically confirmed. This series is compared with other published series of bone aspirations in terms of technique, accuracy and ability to obtain diagnostic material. The importance of technique, radiographic investigations and experience in performing the aspirations in achieving a high diagnostic yield is emphasized.     

Cytologic diagnosis of metastatic hepatocellular carcinoma presenting as an orbital mass. A case report

BACKGROUND: Hepatocellular carcinoma (HCC) metastasizing to the orbit is extremely rare. In the 13 cases reported in the English-langnage literature, the diagnosis was confirmed by fine needle aspiration (FNA) cytology only once. This is the second such case to be diagnosed by FNA cytology and the first to be reported from the Indian subcontinent. CASE: A 76-year-old woman presented with progressive proptosis, bulging of the globe and loss of vision in the right eye. Clinical and radiologic evidence favored a primary orbital tumor with liver metastasis. Cytologic examination of aspirated material from the orbital and liver masses showed features similar to those of HCC. CONCLUSION: Recognition of the cytologic features of HCC permits its diagnosis in metastatic sites. FNA can be employed as an effective tool for diagnosing HCC at metastatic sites, especially when biopsy is technically difficult.     

Fine needle aspiration cytology of bone lesions. Analysis of a three-year experience in rural Africa

FNA biopsies were performed on 24 patients with bone lesions. Cytology diagnosed ten of the cases as classic Burkitt's lymphomas. The cytodiagnoses in the remaining 14 cases were primary bone tumors (5 cases), bone cysts (2 cases), inflammatory lesions (4 cases) and inadequate material (3 cases). Smears of the Burkitt's lymphomas of the jaw contained starry sky macrophages and neoplastic lymphoid cells with deep basophilic cytoplasms and fine vacuolizations. Taking into consideration the load of Burkitt's lymphoma cases in Africa, FNA cytology appears to be a very simple method for getting a quick tissue diagnosis (results were available within 24 hours). For doctors working in tropical hospitals with limited facilities, FNA cytopathology is very useful for distinguishing between tumors and inflammations and for differentiating between benign and malignant tumors.     

Pulmonary sclerosing hemangioma. Report of a case with diagnosis by fine needle aspiration.

Sclerosing hemangioma is a rare but well-recognized benign lesion of the lung. We report a case of pulmonary sclerosing hemangioma correctly diagnosed by fine needle aspiration (FNA) cytology. The sharp and smooth contour of the discrete mass in the left lower zone of the chest roentgenogram raised the possibility of a benign lesion, including pulmonary sclerosing hemangioma. The characteristic "blood spaces" with surrounding regular, bland polygonal tumor cells in the FNA smears provided an essential clue to the diagnosis of sclerosing hemangioma. It was confirmed by Surecut biopsy of the lesion. The patient remained well one year after the investigation and was spared an unnecessary diagnostic thoracotomy. The cytologic features and differential diagnoses of pulmonary sclerosing hemangioma are discussed. Besides delineating the cytologic characteristics of pulmonary sclerosing hemangioma, this case illustrates the importance of a careful clinicopathologic correlation, which should be exercised by the cytopathologist in all instances.     

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.     

Cytodiagnosis of bone tumors by fine needle aspiration

A retrospective study was undertaken of bone lesions examined by preoperative fine needle aspiration (FNA) cytology in our hospital during the ten-year period from 1970 to 1979. The 430 cytologically examined lesions were classified into three groups: inflammatory lesions, tumorlike lesions and tumors. A total of 54 patients had undergone surgery, with most of the lesions in those cases proven to be tumors or tumorlike by histologic study. Correlation between the histologic and FNA cytologic findings showed complete compatibility in 76% of the cases, partial compatibility in 13% and incompatibility in 11%. It is concluded that FNA biopsy is appropriate for identifying bone tumors and tumorlike lesions if sufficient numbers of tumor cells are obtained for morphologic examination. Although aspiration cytodiagnosis can be of considerable value in the recognition of certain bone lesions, it cannot replace formal tissue biopsy in the diagnosis of primary bone neoplasms. The morphology of several common bone tumors is described in detail and their differential diagnosis is discussed.     

Fine needle aspiration cytology diagnosis of cutaneous leishmaniasis in a 6-month-old child: a case report.

BACKGROUND: Skin biopsy and scrape smear examination are the two most commonly employed investigatory techniques in the diagnosis of cutaneous leishmaniasis. Although cases Leishmania lymphadenitis are reliably diagnosed with fine needle aspiration (FNA) cytology, it has not attained popularity in the diagnosis of cutaneous leishmaniasis, and only a few reports are available. CASE: A 6-month-old Kuwaiti child presented with a skin lesion on her left forearm of five months' duration. Both scrape smears and FNA were performed from the lesion. FNA cytology smears showed a rich population of inflammatory cells predominating in lymphocytes and histiocytes and epithelioid cell granulomas. The amastigote forms of Leishmania were noted on the smears. The scrape smears were nondiagnostic. CONCLUSION: FNA cytology can be reliably used in the diagnosis of cutaneous leishmaniasis, especially in dry lesions, where scrape smears are likely to be nondiagnostic.     

Fine needle aspiration cytology of soft tissue tumors

OBJECTIVE: To review of the value of fine needle aspiration (FNA) cytology in the diagnosis of soft tissue tumors (STT). STUDY DESIGN: A review of the literature was coupled with the authors' experience with indications, diagnostic specificity and pitfalls; clinical information; and the final cytology report. RESULTS: Over the last few years, FNA has come to be considered a valuable tool in the management of STT in that it affords a specificity of > 90%. FNA is of particular value in any subcutaneous lesion > 5 cm, in all pediatric tumors and whenever direct incision biopsy is particularly contraindicated. Material from aspirates can be used to obtain cytologic smears for conventional staining, special pigment identification, histochemical techniques, cell blocks for paraffin embedding and ancillary techniques (immunocytochemistry, electron microscopy, and densitometric and cytogenetic analyses). The cytologic diagnosis, like its histologic counterpart, should be based on a correct evaluation of clinical data (age, localization, size, effect on bone, nerve and vessel involvement), radiologic information, cytologic findings (architectural pattern, cell and stroma characteristics) and results of special staining techniques. The final cytology report should place the tumor in one of three basic categories: benign, malignant, and inconclusive or undetermined. Wherever possible, a histopathologic diagnosis should also be provided, either based on purely cytologic criteria or aided by ancillary techniques. CONCLUSION: FNA does not present major complications and permits a swift, preliminary diagnosis in a large number of cases. The method is most effective when the aspiration is performed by an experienced pathologist.     

Cytology of abnormal nipple discharge: a cyto-histological correlation

Spontaneous or expressible nipple discharge may occur in palpable and nonpalpable breast lesions. The aim of the study was to evaluate the sensitivity and specificity of nipple discharge cytology in palpable and nonpalpable breast lesions. One hundred and seventy-four nipple discharge specimens were reviewed, of which 82 had corresponding surgical pathology, including 34 palpable breast lesions and 48 nonpalpable breast lesions. There was good correlation between nipple discharge cytology and concomitant fine needle aspiration (FNA) cytology. Nipple discharge cytology is as specific as concomitant FNA cytology but is slightly less sensitive in detecting papillomas or malignant lesions. The sensitivity and specificity of the nonpalpable and palpable breast lesions were similar. Nipple discharge cytology is very helpful in detecting an underlying breast lesion even if the case has no palpable mass in the breast.     

Fine needle aspiration in a malignant lymphoepithelial lesion: a case report

BACKGROUND: A primary malignant lymphoepithelial lesion (MLEL) of the salivary gland is a rare tumor. Though histologic morphology of this lesion is well documented, the cytologic findings regarding fine needle aspiration (FNA) are not yet well described. CASE: A 56-year-old Thai woman from Udonthanee was admitted to Srinagarind Hospital with a 2-year history of a painless mass in the left parotid gland. FNA of the left parotid mass was performed, and findings suggestive of malignancy were discovered. A wide local excision was performed 1 year later, and MLEL with metastasis to the regional lymph nodes was diagnosed by histopathology. CONCLUSION: We report our first experience of cytologic findings from FNA of histologically diagnosed MLEL. The aspirate comprised groups of cohesive and isolated malignant epithelials with a background of numerous lymphocytes. Cytotechnologists should be reminded of this rare lesion when confronted with a lymphocytic background from either benign or malignant lesions.     

Fine needle aspiration cytology in the diagnosis of bone lesions

OBJECTIVE: Fine needle aspiration cytology (FNAC) in combination with radiological examination has recently gained clinical recognition for evaluating skeletal lesions. We evaluated our experience with the use of FNA in diagnosing bone lesions with emphasis on areas of difficulty and limitations. MATERIALS AND METHODS: Over a period of 5 years FNA was performed in 66 cases of bone lesions. Aspirations were done by cytopathologists using 22-gauge needle. Out of 66 cases unsatisfactory aspirate was obtained in 12 cases. Cytohistological correlation was available in 19 cases. RESULTS: Adequate aspirates were categorized into neoplastic (27 cases) and non-neoplastic (27 cases) lesions. Of the 27 neoplastic aspirates, 20 were malignant (12 primary, 8 metastatic deposits) and 7 were benign. In the malignant group osteosarcoma was correctly diagnosed in 3 cases while other 3 were labeled as sarcoma NOS because of lack of osteoid. Metastatic deposits were sub-typed in 6 cases; from renal cell carcinoma (3 cases), proststic adenocarcinoma, follicular carcinoma thyroid, and squamous cell carcinoma. Neoplastic group comprised of 6 cases of cysts and 21 cases of chronic osteomyelitis. Thirteen cases were diagnosed as tuberculous osteomyelitis. CONCLUSIONS: FNA is a frequent indication in metastases in the bone where distinct cytologic features can even identify an unknown primary. However, diagnosis of primary tumours of the bone is limited by precise subtyping of the tumours. FNA has emerged as a cost effective tool for initial diagnosis of both neoplastic and non-neoplastic lesions of the bone.     

Fine needle aspiration cytology of "minimal" breast cancer

The value of fine needle aspiration (FNA) cytology in the diagnosis of "minimal" breast cancer was studied. Sixteen (76.2%) of 21 cases of invasive breast cancer less than 1.0 cm in diameter and 14 (73.3%) of 19 cases of noninvasive breast carcinoma were given a positive diagnosis by FNA cytology. One "suspicious" and the five false-negative diagnoses occurred in cases of invasive carcinoma; the reasons were considered to be either a faulty technique of needling the tumor or the presence of prominent fibrosis in the tumor. In noninvasive carcinoma, atypical cells were misdiagnosed in two of the five smears that had been originally reported as negative. The results of the retrospective analysis showed that FNA cytology had a higher accuracy in the diagnosis of small lesions than did radiologic and echographic criteria, and FNA cytology was thus used as the main criterion for deciding on the necessity for preoperative surgical biopsies.     

Fine needle aspiration cytology in the management of palpable benign and malignant breast disease. Correlation with clinical and mammographic findings

Two surgeons in a health maintenance organization group practice performed 280 fine needle aspirations (FNAs) on 257 palpable breast lesions in 200 patients. The cytology was interpreted by four pathologists at a community hospital. FNA cytology had a sensitivity of 96% and a specificity of 94% in these cases; there were no false-positive diagnoses of cancer. FNA cytology improved the identification of benign disease and decreased the risk of missing cancers. FNA cytology also improved the predictive value of mammographic information and was more helpful than mammography in demonstrating the need for biopsy of small palpable lesions that turned out to be "minimal" breast cancers.