Fine needle aspiration cytology of salivary gland lesions

Eighty-eight fine needle aspirates from 79 salivary gland lesions in 77 patients were examined. The overall diagnostic sensitivity was 84% and the specificity 98.41%. When the 14 unsatisfactory specimens were excluded the sensitivity rose to 95.45%. Correct identification of the disease process was possible in nearly 80% of cases with a final benign diagnosis. The histological tumour type was correctly predicted in 75% of the malignancies. In the others the cytological diagnosis was anaplastic malignant neoplasm.     

Fine needle aspiration (FNA) cytology of pilomatrixoma

FNA smears from five histologically confirmed cases of pilomatrixoma were reviewed to delineate the cytological features helpful in diagnosis. A combination of basaloid cells, ghost cells and foreign body giant cells appeared to be necessary in FNA smear for a confident cytodiagnosis of pilomatrixoma. Presence of naked nuclei, nucleated squamous cells and calcification were additional features in favour of the diagnosis. Another 10 cases with initial cytodiagnosis of pilomatrixoma or benign skin appendage tumour were reviewed. Using the above criteria, diagnosis of pilomatrixoma was easy in five cases. One case was problematical due to presence of atypical squamous cells. Initially the cytological features were most commonly confused with epidermal inclusion cyst, giant cell lesion or a squamous cell carcinoma. The main reasons for erroneous diagnosis were lack of awareness of cytological features, predominance of one component over the others, and non‐representative FNA smears. Atypia in nucleated squamous cells, and misinterpretation of basaloid cells as malignant can lead to diagnostic dilemma. Adequate clinical data are also necessary.     

Fine needle aspiration (FNA) cytology of extra-adrenal paragangliomas

Fine needle aspiration (FNA) cytology of extra-adrenal paragangliomas We studied nine histologically proved cases of extra-adrenal paragangliomas. Of these, eight cases were correctly diagnosed preoperatively by FNA cytology. Salient cytological features included clusters and discretely scattered cells, with occasional acinar configuration. The cells showed moderate to abundant slightly basophilic cytoplasm with ill-defined margins and round to oval nuclei with mild to marked nuclear pleomorphism. Fine reddish intracytoplasmic granules were also noted (six cases). Cytological features along with clinical data are quite diagnostic of paragangliomas. A correct preoperative cytological diagnosis helps to prevent undue surgical complications. Cytologie par ponction aspiration à l'aiguille fine des paragangliomes extra-surrénaliens Nous avons étudié 9 cas de paragangliomes extra-surrénaliens histologiquement prouvés. Huit cas sur 9 ont été correctement diagnostiqués, à titre pré-opératoire, par cytologie par ponction aspiration à l'aiguille fine. Les caractéristiques cytologiques principales sont la présence d'amas, une dispersion cellulaire modérée et d'occasionnelles formations acineuses. Les cellules comportent un cytoplasme légèrement basophile, moyennement à très abondant, avec des limites mal définies ainsi qu'un noyau rond ou ovale, dont le pléomorphisme nucléaire est modéré ou plus nettement marqué. Le présence de fines granulations rougeâtres intra-cytoplasmiques a également été notée (6 cas). Ces caractères cytologiques, associés aux données cliniques, permettent pratiquement le diagnostic des paragangliomes. Un diagnostic cytologique pré-opératoire correct favorise la prévention des complications chirurgicales indésirables. FNP extraadrenaler Paragangliome Neun histologisch gesicherte Fälle extraadrenaler Paragangliome werden vorgestellt. Präoperativ waren 8 der Fälle zytologisch durch FNP richtig diagnostiziert worden. Charakteristisch waren Einzelzellen und z.T. azinäre Verbände. Die Zellen zeigten mässig bis reichlich, leicht basophiles, unscharf begrenztes Zytoplasma und rund-ovale Kerne mit leichter bis ausgeprägter Pleomorphie. In 6 Fällen lagen feine, rote Granula im Zytoplasma vor. Das zytologische Bild in Zusammenschau mit den klinischen Daten erlaubt eine sichere Diagnose. Auf diese Weise können die operativen Risiken vermindert werden.     

Fine needle aspiration (FNA)-induced necrosis of tumours of the thyroid

Two cases of necrosis of thyroid oxyphilic tumours following FNA are reported. the first patient received surgery 4 weeks after FNA and histological examination revealed an encapsulated and totally necrotic tumour 2 cm in diameter. In the second patient surgery was performed after 25 days. Histological examination showed a 0.7 cm diameter tumour consisting mainly of fibrous tissue with residual oxyphilic tumour cells only in a small peripheral rim. In both patients no capsular or vascular invasion and no blood vessel thrombosis were present. A review of the literature revealed that oxyphilic tumours are susceptible to post-FNA necrosis, which might be due to the compromised vascular supply after FNA in conjunction with the intrinsic energy deficiency of oncocytic tumour cells.     

Fine needle aspiration (FNA) cytology of pilomatrixoma: report of 14 cases and review of the literature

We describe 14 cases of pilomatrixoma which were diagnosed preoperatively on FNA cytology. In contrast to the literature, our series showed male preponderance and some of the tumours in unusual locations such as thigh and breast. In three patients the tumours were larger than 5 cm. The clinical diagnosis varied from tumour not otherwise defined to sarcoma. The cytologic presentation had features which allowed a correct diagnosis in all cases and included basaloid cells surrounded by delicate pink fibres, shadow cells, giant cells, naked nuclei and calcium deposits. It is concluded that the FNA cytology of pilomatrixoma is characteristic and will allow a conclusive diagnosis even in cases with an aberrant clinical presentation.     

Diagnosis of fibromatosis colli by fine needle aspiration (FNA) cytology

This study presents eight cases of fibromatosis colli accurately diagnosed by FNA cytology. Fibromatosis colli is a rare fibroblastic lesion that manifests in the sternocleidomastoid muscle during the first to second months after birth. The tumours varied in size from 1 to 3 cm and engaged the lower, middle as well as the upper part of the sternocleidomastoid muscle. The FNA cytology smears showed mostly mature fibroblasts in a background of pink granular material and fragments of striated muscle fibres with degeneration. The cytological presentation together with the typical clinical setting will allow a definitive and accurate diagnosis, avoiding surgery.     

Fine needle aspiration cytology of salivary gland lesions: advantages and pitfalls

Fine needle aspiration cytology (FNAC) was performed on 52 patients with salivary gland lesions. A definitive cytodiagnosis was possible in 45 cases: a sensitivity of 89% and a specificity of 94% was achieved. The pitfalls of FNAC of salivary gland lesions are reflected by the false positive and false negative rates which were 4%. Errors of cytodiagnosis are due to the morphological variability of these tumours which make sampling and interpretation difficult.     

Fine needle aspiration cytology of minor salivary gland tumours of the palate

Fine needle aspiration cytology of minor salivary gland tumours of the palate This retrospective study was carried out to review aspirates from minor salivary gland tumours of the palate and to assess the problems encountered in their diagnosis, especially the cytological diagnosis of newer entities such as polymorphous low grade adenocarcinoma (PLGA). Fifty-five cases of palatal salivary gland tumours aspirated over a period of 16 years were reviewed. Histology was available in 26 cases. Pleomorphic adenoma (27 cases) was the most common benign cytodiagnosis. Eleven aspirates were malignant tumours of which eight cases were adenoid cystic carcinoma and three cases were mucoepidermoid carcinoma. Seven cases were diagnosed on fine needle aspiration as suggestive of PLGA. However histological confirmation was available in only one of these cases. Concordance between the initial and revised typings of the tumours was seen in only 28 cases (54%) in the present study. Initially 18 of the 51 tumours (35.3%) could not be typed; and after review, only three could not be typed. Three cases of oncocytoma could be diagnosed on review only. Palatal salivary gland tumours, although relatively uncommon, are difficult to diagnose cytologically. This is more so in cases of newer entities such as PLGA, as their cytological diagnosis is still not well characterized.     

Fine needle cytology of palpable head and neck lesions: a comparison of sampling methods with and without suction

Patients attending the ear, nose and throat (ENT) department at St James's University Hospital, Leeds, UK, for evaluation of palpable head and neck lesions have a fine needle cytology (FNC) specimen taken and receive the result at the same out-patient visit. This study was designed to discover if there is a significant difference in the efficiency of the methods with and without suction. The method was chosen randomly on each occasion and the adequacy or otherwise of the specimen was determined taking into account the site and nature of the lesion and the total cellularity of the sample. The level of blood contamination was also compared by each method. When benign and malignant lesions from all sites were analysed together the method with suction produced a significantly higher number of adequate samples than the method without suction. The exception was in the case of samples from lymph node lesions measuring < 1 cm, where adequate specimens were only obtained without suction. The non-suction technique was particularly poor at sampling salivary gland lesions in the 1–1.5 cm category. There was no significant difference in the level of blood contamination between the two methods at any site. These results are at variance with most other similar studies and possible reasons for this are discussed.     

Fine needle aspiration (FNA) cytology of Rosai Dorfman disease

deshpande v and verma k. (1998) Cytopathology 9, 329–335
Fine needle aspiration (FNA) cytology of Rosai Dorfman disease
Rosai Dorfman disease (sinus histiocytosis with massive lymphadenopathy (SHML)) is a benign self-limiting disorder that commonly involves the lymph nodes. We reviewed eight cases of this entity aiming to document the cytomorphological features. Of the eight cases, a preoperative diagnosis was suggested in seven cases. Pertinent features included: numerous large histiocytes with prominent emperipolesis (documented by a halo around the cell), fine vacuoles in the cytoplasm and lymphocytes and plasma cells in the background. In some cases the histiocytes showed atypia. In one biopsy-proven case a diagnosis of Hodgkin's was suggested, emphasizing the pitfalls associated with the FNA diagnosis of this lesion.     

Fine needle aspiration cytodiagnosis of anaplastic carcinoma and malignant haemangioendothelioma of the thyroid in an endemic goitre area

Between 1970 and 1987, 20,028 fine needle aspirates (FNA) of the thyroid have been examined in the Department of Pathology of the University of Innsbruck, Austria. During this period 92 cases of anaplastic carcinoma and 16 cases of malignant haemangioendothelioma (MHE) of the thyroid were diagnosed. Forty-three out of these 108 highly malignant tumours of the thyroid underwent FNA pre-operatively (39.1%). Thirty-seven FNA contained numerous cells of a highly malignant tumour. Five specimens (11.8%) contained only necrotic material and inflammatory cells. In one case of an anaplastic carcinoma no malignant cells could be demonstrated in FNA. We conclude that pre-operative FNA of highly malignant thyroid tumours may contribute substantially to subsequent clinical management.     

Routine audit of breast fine needle aspiration (FNA) cytology specimens and aspirator inadequate rates

Routine audit of breast fine needle aspiration (FNA) cytology specimens and aspirator inadequate rates In an attempt to improve the quality of the breast FNA specimens we instigated a continuing audit of this procedure in this hospital. All FNAs since 1990 have had the following recorded: mode of aspiration, e.g. freehand or image guided, patient presentation (screening or symptomatic), patient diagnostic category, cytological diagnosis and final histological diagnosis. Aspirator performance was assessed by means of the inadequate aspiration rate (IR) of FNAs performed on patients with a final diagnosis of cancer (FDC) and diagnostic category A patients (clinically or radiologically malignant lesions). An ongoing annual review of the performance of all the aspirators was undertaken, all of whom received individual feedback. Counselling and further training were offered where indicated by poor performance. Over the period 1990–1995 a total of 13 537 FNAs were performed by 27 aspirators. The IR on category A and FDC cases over this period was 16.0% and 18.1%. The best performance achieved by an aspirator in a calendar year was an IR of 3.6% with no inadequate specimens in either FDC or category A lesions, and the best performance over the entire period was an average IR of 11.75% and 14.25% for FDC and category A groups, respectively. The overall IR on category A patients ranged from 15.9% to 23.8% and on FDC cases from 12.2% to 21.7%. There was a significant improvement in individual junior aspirator performance when their first year was compared with their last year on the unit. In some cases a deterioration in intra-aspirator performance was observed, from an IR of 6% to 33%. The overall IR rate of the unit remained stable for FDC patients, 15.5% in 1990 compared with 15.1% in 1995. This appeared to be largely due to a high proportion of the aspirations being performed by experienced personnel with consistent IRs. However, concealed within the overall rate there were some poor performers who benefited from counselling and/or further training. These results indicate an important role for audit in identifying poor aspirators who benefit from targeted training and advice, thereby improving the quality of FNA specimens, and ultimately patient care.