Spermatic granuloma. Diagnosis by fine needle aspiration cytology

Spermatic granulomas may present as tumorlike lesions adjacent to the testis or seminal vesicle and are often associated with infection, trauma or previous surgery. The fine needle aspiration biopsy cytologic findings in three cases of spermatic granuloma are reported. The predominant cytologic features were granulomatous inflammation (nontuberculous and non-foreign body) and spermatozoids (intrahistiocytic or as extracellular spermatic debris). Additional features included lymphoid cells and lymphocytic debris (nuclear tangles), rare plasma cells and eosinophils. Germ cells and acellular (caseous) necrosis were not identified. Well-preserved sheets of epididymal epithelium were occasionally noted. The clinical and cytologic differential diagnoses in such cases are discussed.     

Burkitt-type lymphoma. Diagnosis by fine needle aspiration cytology

Forty cases of lymphoma were categorized as Burkitt-type lymphoma in a study of fine needle aspiration (FNA) smears. These constituted 14.3% of all cases of non-Hodgkin's lymphoma diagnosed between 1974 and 1982. The median age was 22 years in these cases, 81.8% of which had extranodal tumors. The majority of the cells in the smears (59.8% +/- 8.32%) were in the 11 micron to 15 micron size range and 60.3% +/- 10.3% had noncleaved nuclei. An average 71% of the cells contained cytoplasmic and/or nuclear vacuolizations. Nonneoplastic macrophages were present in the smears in 87.5% of the cases. A study of paraffin-embedded sections in 17 cases revealed the characteristic "starry-sky" appearance in 11; in 5 it was not clearly appreciated and in 1 the nonneoplastic macrophages were absent. FNA cytology was found to be quite reliable for arriving at a diagnosis of Burkitt-type lymphoma. More than 50% of the cases were managed without resort to subsequent surgical biopsy. Exploratory laparotomy was avoided in 69% of the cases having abdominal tumors.     

Diagnosis of intestinal malakoplakia by fine needle aspiration cytology

Two cases of intestinal malakoplakia were diagnosed by fine needle aspiration (FNA) cytology. Clinically, these cases were mistaken for a lymphoma and a tuberculosis. Percutaneous abdominal FNA material showed numerous macrophages with the characteristic Michaelis-Gutmann bodies. These bodies were easily identified both inside and outside the macrophages in the smears.     

Amphicrine carcinoma of the lung. Diagnosis by fine needle aspiration cytology

A case of pulmonary carcinoma with dual (glandular and endocrine) differentiation diagnosed by fine needle aspiration cytology is reported. By light microscopy, the neoplastic cells showed mucicarmine, periodic-acid Schiff, and Grimelius silver positivity. On immunostaining, neuron specific enolase, chromogranin, calcitonin and serotonin were demonstrated. Electron microscopy revealed two different types of distinctive cytoplasmic inclusions in the same cell, namely: carcinoid type of neurosecretory granules and mucin droplets. Diagnostic criteria and possible histogenesis of this rare tumour entity are discussed.     

Diagnosis of hepatocellular carcinoma by fine needle aspiration cytology. Cellular features

OBJECTIVE: To evaluate the importance of fine needle aspiration cytology (FNAC) in the diagnosis of hepatocellular carcinoma (HCC). STUDY DESIGN: We analyzed 17 cytologic and 5 architectural features in a series of 320 FNACs from HCC and compared them with 73 FNACs from benign lesions and with 705 FNACs from metastatic carcinomas. One thousand ninety-eight patients who were diagnosed by liver FNAC between December 1988 and July 1998 and had adequate follow-up were included in the study. The specimens were evaluated according to the presence or absence of the cytologic features and cellular arrangement. A stepwise logistic regression analysis was performed on the data to determine the variables predictive of HCC. RESULTS: Multinucleated tumor giant cells, cytoplasmic hyaline and central sinusoidal pattern were selected as the 3 most predictive parameters for differentiated reactive hepatocytes from HCC (P < .0001), while bile, centrally located nucleus in an atypical cell and intranuclear inclusion were selected as the 3 most predictive parameters for differentiated metastatic carcinoma from HCC (P < .0001-< .001) by stepwise logistic regression analysis. CONCLUSION: In the 1,098 patients suspected of having hepatic malignancy, a correct diagnosis was made by a combination of the above features. The sensitivity of this procedure for hepatic malignancy was 99.5%, and the specificity was 100%.     

Endometriosis of the rectovaginal septum. Diagnosis by fine needle aspiration cytology

The cytologic picture seen in two cases of rectovaginal endometriosis diagnosed by fine needle aspiration (FNA) cytology is presented in detail. The cell pattern differed considerably from that previously described in fluid specimens and more closely resembled the exfoliation observed in direct endometrial samples. No previous report appears to exist on the diagnosis of rectovaginal endometriosis by FNA.     

Thoracic splenosis. Diagnosis of a case by fine needle aspiration cytology

Fine needle aspiration cytology was used to study chest wall nodules in a patient who presented with fever, cough, pleuritic chest pain and cytomegalovirus infection and who had a previous history of abdominal trauma. The finding of splenic red pulp and white pulp in the aspirate, combined with the results of a radionucleotide liver-spleen scan, led to a diagnosis of thoracic splenosis, a relatively rare condition. Splenosis is thought to result from transplantation of splenic tissue after trauma and may provide some added protection against certain infectious conditions, both of which were present in this case.     

Diagnosis of prostatic leiomyosarcoma with fine needle aspiration cytology

A case of prostatic leiomyosarcoma initially diagnosed by fine needle aspiration cytology is reported. The cytologic findings on prepared smears are described. The value of a cell block preparation of the aspirate in establishing a definite diagnosis is discussed, and the differential diagnosis is briefly discussed.     

Osteoclastomalike anaplastic carcinoma of the thyroid. Diagnosis by fine needle aspiration cytology

Fine needle aspiration (FNA) of a neck mass yielded cytologic specimens containing two cell populations: multinucleated giant cells and smaller, round-to-oval, undifferentiated malignant cells. The giant cells were frequently so numerous as to obscure the other cells. The FNA cytodiagnosis of a rare anaplastic thyroid carcinoma containing osteoclastic giant cells was substantiated by the subsequent exploratory surgery and biopsy specimen. Immunohistochemical staining suggested a dual origin of the two cell populations.     

Extraskeletal Ewing's sarcoma. Diagnosis of a case by fine needle aspiration cytology

A retroperitoneal mass was subjected to fine needle aspiration biopsy for cytologic evaluation. The aspirate consisted of a monotonous population of undifferentiated tumor cells whose cytologic appearance was consistent with a small-cell (Ewing's) sarcoma. The differential diagnosis of extraskeletal Ewing's sarcoma from other small-cell neoplasms, such as lymphoma, neuroblastoma and other soft-tissue sarcoma, cannot be made solely on the basis of morphologic studies. As in this case, histochemical studies and consideration of the clinical features are needed to make the final diagnosis.     

Diagnosis of malignant granular cell tumor by fine needle aspiration cytology:.

BACKGROUND: Malignant granular cell tumors (GCT) are the rarest of all sarcomas, and the histologic differentiation from their benign counterpart may be extremely difficult or impossible unless metastatic disease is demonstrated. To our knowledge, this is the first report of a malignant GCT diagnosed by fine needle aspiration (FNA) cytology. CASE: A 70-year-old, Caucasian female presented with a progressively enlarging left supraclavicular mass. FNA of the mass revealed a metastatic tumor cytologically consistent with GCT. With this diagnosis, a search for other metastatic sites was initiated. Computed tomography (CT) scan revealed several tumor nodules in the lungs and liver. CT-guided FNA and tru-cut needle biopsy of a liver mass confirmed the diagnosis of metastatic GCT. In searching for a primary site, the patient revealed a clinical history of having had a tumor removed from her back two months before; it was reported to be an atypical GCT. Comparison of the three tumors revealed similar histologic, cytologic and immunohistochemical features. CONCLUSION: Evidence of mild to moderate cytologic atypia; increased mitotic activity; locally aggressive growth; increased proliferative activity as demonstrated by immunohistochemical evaluation of proliferation markers; and DNA ploidy analysis, as reported for this case, may be helpful in predicting malignant behavior of GCTs.     

Renal fine needle aspiration cytology

OBJECTIVE: To audit and evaluate the pitfalls in renal fine needle aspiration (FNA) cytology. STUDY DESIGN: A retrospective analysis of 180 renal FNAs from 163 patients, encountered at Canberra Hospital, Australian Capital Territory, between June 1989 and July 1997 was undertaken. The FNA procedures had been performed by radiologists under computed tomography (CT) or ultrasound (US) guidance. The study correlated the FNA results with biopsy findings and clinical outcome. RESULTS: The initial cytologic diagnoses included 84 (47%) benign, 6 (3%) atypical, 7 (4%) suspicious, 70 (39%) malignant and 13 (7%) inadequate. Six of the 13 cytologically inadequate group, on further investigation, had malignant histology. The benign cytologic categories contained 79 benign conditions and 5 cases with a malignant outcome. The atypical cytologic group contained 5 benign and 1 malignant case. All nine cytologically suspicious cases had malignant histology. The cytologically malignant group contained 62 malignant, 7 benign and 1 patient lost to follow-up. The sensitivity was 92.5%, specificity was 91.9%, positive predictive value was 89.9%, negative predictive value was 94.0%, and efficacy of the test was 92.2%. CONCLUSION: Renal FNA can provide an accurate diagnosis in most instances; however, aspiration cytology of the kidney has limitations and pitfalls. Low grade renal cell carcinoma has to be differentiated from oncocytoma, angiomyolipoma, renal infarct and reactive conditions. Renal FNA has a high negative predictive value, which is useful in reassuring patients with radiologically and cytologically benign lesions. Negative FNA does not exclude malignancy in the presence of a radiologic suspicion.     

Pitfalls in fine needle aspiration cytology.

A review of pitfalls encountered in fine needle aspiration cytology (FNAC) of all organs and tissues and based mainly on the author's 35-year experience of diagnostic FNAC in clinical practice is presented. Diagnostic difficulties are usually related to deviations from common cytological criteria that may occur in some lesions. Others are due to the effects of the sampling procedure or of the preparation of samples. A few basic rules are proposed, which may help to avoid some of the diagnostic pitfalls.