Fine needle aspiration cytology of epithelioid angiosarcoma: a case report

BACKGROUND: Malignant vascular tumors are rare. Few studies have described cytomorphologic features of hemangioendothelioma and angiosarcoma on fine needle aspiration cytology (FNAC). Malignant vascular tumor with epithelioid morphology can create diagnostic difficulty, as the cytology may simulate that in other nonvascular malignant tumors. We describe epithelioid angiosarcoma, diagnosed on FNAC, in which a differential diagnosis of histiocytosis and inflammatory granulation tissue was considered. CASE: A 20-year-old man presented with forehead and scalp swellings. The forehead lesion was radiologiocally associated with a lytic lesion in the bone. FNA resulted in high cellular yield, and smears revealed prominent vascular pattern with endothelial cell atypia and histiocytoid/epithelioid neoplastic cells, occasional mitotic figures and a few cells displaying nuclear grooving. Smear background showed a significant number of neutrophils. Epithelioid hemangioendothelioma/angiosarcoma, histiocytosis and inflammatory granulation tissue were considered. A cytologic diagnosis of epithelioid angiosarcoma/epithelioid hemangioendothelioma was suggested and confirmed on histopathologic and immunohistochemical examination. CONCLUSION: Cellular aspirates from malignant epithelioid endothelial tumors involving bone may be cytologically mistaken for histiocytosis and, rarely, inflammatory granulation tissue. However, prominent vascular pattern with striking endothelial cell atypia, presence of mitotic figures and careful search for presence of endothelial differentiation are helpful in accurate cytologic diagnosis.     

Fine needle aspiration cytology of a sebaceous lymphadenoma: a case report

BACKGROUND: Sebaceous lymphadenoma is a rare, benign neoplasm, histologically characterized by proliferating islands of epithelium with sebaceous glandular differentiation in a dense, lymphocytic background. The parotid gland is the most common site, and the patient usually presents with a well-circumscribed, enlarging and painless mass. Primary sebaceous lesions of the salivary glands are very rare entities and must be differentiated from more common, potentially malignant tumors. CASE: A 75-year-old male presented with a 6-month history of a mass in the tail of the parotid gland. The mass was not fixed or tender to palpation, was well delineated and measured 4 cm in greatest dimension. Fine needle aspiration (FNA) revealed a mixed population of large and small lymphocytes, including plasma cells and occasional tingible body macrophages. Scattered among the lymphocytes were 3-dimensional, cohesive aggregates of epithelial cells, many demonstrating the characteristic cytoplasmic vacuolization of sebocytes, surrounded by layers of basaloid cells. No mitoses or cellular pleomorphism was identified. These findings suggested a sebaceous lymphadenoma, confirmed on biopsy. CONCLUSION: Although sebaceous lymphadenoma is encountered infrequently, FNA findings can result in its accurate diagnosis.     

Fine needle aspiration cytology of well-differentiated papillary mesothelioma: a case report

BACKGROUND: Well-differentiated papillary mesothelioma (WDPM) is an uncommon subtype of mesothelioma that typically occurs in the peritoneum of women without a history of asbestos exposure and usually follows an indolent clinical course. Fine needle aspiration (FNA) of this type of tumor has rarely been reported. CASE: A 64-year-old woman with 11-year history of colon cancer and an adrenal nodule was found, on abdominal computed tomography, to have a mass in the right lobe of the liver. Aspirates of the mass were composed of abundant, tight, papillary groups, monolayered, pavementlike sheets; and scattered single cells with minimal atypia. The cell block showed a predominantly papillary growth pattern and a single layer of bland, cuboidal to flattened covering cells with stout, fibrovascular cores containing clusters of foamy histiocytes. Tumor cells in the focal tubulopapillary and solid areas were mingled with inflammatory cells and showed slightly more atypia than did the cells covering the papillae. The differential diagnoses were intrahepatic papillary neoplasm, including well-differentiated mesothelioma and metastatic low grade papillary serous carcinoma. At surgery the tumor was found to be a pedunculated peritoneal mass that arose from the posterior surface of the right lobe of the liver. The mesothelial origin of the tumor was confirmed by both immunoperoxidase study and electron microscopic examination, which demonstrated long, slender, branching microvilli. CONCLUSION: Familiarity with the cytomorphologic features and clinical presentation of WDPM, knowledge of the exact anatomic location and consideration of the appropriate differential diagnosis combined with ancillary studies are the keys to an accurate diagnosis.     

Fine needle aspiration cytology of juvenile hyaline fibromatosis: a case report

BACKGROUND: Juvenile hyaline fibromatosis (YHF) is a rare inherited disorder characterized by tumorous growth of hyalinized fibrous tissue. No report on cytomorphology of this condition is available in English on MEDLINE. CASE REPORT: A 6-year-old girl had multiple nontender nodules on both ear lobes, nose and scalp. Fine needle aspiration of the nodule on the left ear revealed benign, spindle-shaped cells with an eosinophilic ground substance in the background. The diagnosis of JHF was made following cytologic and histopathologic studies. CONCLUSION: Fine needle aspiration cytology is reliable for the diagnosis of JHF.     

Fine needle aspiration cytology of metastatic olfactory neuroblastoma: a case report

BACKGROUND: Olfactory neuroblastoma (ONB) is an uncommon tumor, presenting as a polypoid mass arising from the upper nasal cavity. This tumor has been seldom diagnosed by direct fine needle aspiration (FNA). CASE: Metastatic ONB was diagnosed by FNA. The patient was a 40-year-old female with a polypoid mass in the nasal cavity and ipsilateral cervical lymphadenopathy. The punch biopsy of the nasal tumor revealed a smudged small round cell neoplasm with neuroendocrine differentiation, consistent with ONB. In FNA smears from the cervical lymph node, there were well-preserved, small, monotonous cells with hyperchromatic nuclei, fibrillary cytoplasm and indistinct cell borders. Also noteworthy were occasional pseudorosettes as well as rare true rosettes. By immunocytochemistry, tumor cells were positive for cytokeratin, chromogranin and synaptophysin. CONCLUSION: ONB, like adrenal neuroblastoma, shows distinctive cytologic features, including a rosette or pseudorosette and fibrillary network. FNA can accurately demonstrate these characteristic findings, and in some cases it may be a better diagnostic modality than incisional biopsy.     

Fine needle aspiration cytology of adult perineal rhabdomyosarcoma: a case report

BACKGROUND: Adult perineal soft tissue sarcomas are rare. Fewer than 30 cases have been reported, and all were diagnosed after surgical resection by histologic examination. Below we report a case in which the diagnosis was established preoperatively by fine needle aspiration (FNA). CASE: A 27-year-old man presented with a firm, midline, perineal mass. Magnetic resonance imaging showed a 3-cm, enhancing mass that was considered neoplastic. FNA biopsy, followed by cytologic examination, revealed moderately cellular aspirates composed of discohesive, small, blue cells with scant cytoplasm, high nuclear/cytoplasmic ratios and pleomorphic nuclei with irregular nuclear contours; uniform, hyperchromatic chromatin; and occasional mitotic figures. Frequent naked nuclei and scattered cells with more abundant, dense cytoplasm and eccentric nuclei were also noted. The diagnosis of rhabdomyosarcoma was favored on FNA and was corroborated by immunohistochemical stains for desmin, myogenin and CD56. Upon surgical resection, the diagnosis of alveolar rhabdomyosarcoma was confirmed histologically and immunophenotypically. CONCLUSION: FNA is a useful tool in diagnosing soft tissue lessions of the perineum, including rare primary tumors, such as adult rhabdomyosarcoma. In this case, early identification avoided incisional biopsy and directed appropriate extirpative surgery and reconstruction considerations.     

Fine needle aspiration cytology in recurrent amelanotic melanoma: a case report

BACKGROUND: Amelanotic melanoma can mimic a wide variety of epithelial and nonepithelial malignant tumors. Varied cytomorphology of melanoma has been described on exfoliative and fine needle aspiration cytology (FNAC). We report a case of recurrent amelanotic melanoma to highlight its varied cytomorphologic features, which may cause diagnostic problems on cytologic and on histologic examinations. CASE: A 63-year-old male presented with nodular swellings in the right anterior chest wall, right axilla and back. A nodule in the chest had been excised 6 months earlier. Clinically, the lesion was interpreted as recurrent soft tissue sarcoma. FNAC revealed malignant cells with highly varied morphology with plasmacytoid and pleomorphic malignant cells with occasional fibrocollagenous tissue strands showing adherent neoplastic cells. A cytologic diagnosis of pleomorphic malignant tumor was suggested, and the original histologic slides were reviewed; they showed a striking alveolar pattern that vaguely resembled an alveolar rhabdomyosarcoma. However, on immunohistochemistry, the tumor cells were S-100 and melan-A positive and desmin negative. A final diagnosis of amelanotic melanoma was made. CONCLUSION: Awareness of the highly varied cytomorphology of amelanotic melanoma minimizes the diagnostic difficulty on fine needle aspiration smears. Suitable immunohistochemical markers are of great value in difficult situations.     

Fine needle aspiration cytology in mediastinal myxoid liposarcoma: a case report

BACKGROUND: The mediastinum is an uncommon site for liposarcoma, with <1 % of all tumors occurring in this site. CASE: A 40-year-old woman presented with superior vena caval syndrome. Radiologic investigations revealed the presence of a large soft tissue mass occupying the anterior and middle mediastinum. A computed tomography (CT)-guided fine needle aspiration cytology (FNAC) sample showed the presence of fibrillary myxoid material with arborizing blood vessels and atypical lipoblasts. A diagnosis of myxold liposarcoma was made, which was later confirmed on bistopathology. CONCLUSION: The mediastinum is a challenging area for FNAC, which is a useful tool for accurate diagnosis. Awareness of the presence of liposarcoma is important for its recognition.     

Fine needle aspiration cytology of mixed medullary-follicular thyroid carcinoma: a case report

BACKGROUND: Mixed medullary-follicular thyroid carcinoma (MMFTC) is a rare tumor that has been regarded as a clinicopathologic variant of medullary thyroid carcinoma. MMFTC represents a diagnostic challenge by fine needle aspiration cytology (FNAC). CASE: A 77-year-old woman had a palpable mass on the left side of the neck. It was diagnosed as follicular neoplasm by FNAC; she underwent total thyroidectomy. Pathology revealed follicular carcinoma. Radioactive iodine was administered. An enlarging mass was present in the left mandible later. FNAC showed suspicious follicular neoplasm with predominance of oncocytic cells. Pathology revealed follicular carcinoma with parafollicular cell differentiation. Immunohistochemical analysis demonstrated positive status for thyroglobulin and calcitonin. Simultaneous expression of thyroglobulin and calcitonin within the same neoplastic cell was considered. She underwent several courses of radioactive iodine therapy without significant effect. Interestingly, her serum calcitonin level was not elevated. CONCLUSION: Coexpression of thyroglobulin and calcitonin in the same cell is very rare. The component of medullary carcinoma should be considered when encountering an atypical thyroid carcinoma with predominance of cells showing oncocytic changes on FNAC and with clinically poor response to conventional treatment. Immunohistochemistry and pathologic analyses are helpful to confirm the diagnosis, especially in the absence of elevated serum calcitonin level.     

Fine needle aspiration cytology diagnosis of renal medullary carcinoma: a case report

BACKGROUND: Renal medullary carcinoma is a recently described, highly aggressive neoplasm that affects predominantly young African American males with a history of sickle cell trait. To the best of our knowledge, this is the first report of fine needle aspirate cytology (FNAC) findings of renal medullary carcinoma. CASE: A 14-year-old, African American male with a history of sickle cell trait presented with the sudden onset of third cranial nerve palsy. Radiographic examination demonstrated possible tumor masses in the brain, thorax and left kidney. Ultrasound-guided fine needle aspiration was performed on the left kidney, and a cytologic diagnosis of "suspect renal medullary carcinoma" was rendered. The cytologic diagnosis was confirmed by tissue examination. CONCLUSION: The cytologic features of renal medullary carcinoma include loosely cohesive clusters and single epithelioid cells with cytologic atypia, including high nuclear/cytoplasmic ratios, hyperchromasia, prominent nucleoli and cytoplasmic vacuolation. These cytologic findings, coupled with clinical findings (young black male with sickle cell trait), allow recognition of this rare renal neoplasm.     

Fine needle aspiration cytology of neurothekeoma. A case report

BACKGROUND: Neurothekeoma (NT) is a rare, benign neoplasm of soft parts with a distinctive histologic appearance. To our knowledge, the cytologic findings have not been described before. We present a case of NT with the cytologic features on fine needle aspiration cytology (FNAC). CASE: A 54-year-old female presented with a circumscribed nodule in the left breast. The lesion was evaluated by FNAC. The smears showed an abundant, metachromatic, myxoid matrix with fusiform and epithelioid cells, some binucleated or multinucleated, loose or in groups and sometimes forming concentric whorls. The lesion was removed, and the diagnosis of NT was made after histopathologic study. CONCLUSION: NT is an extremely rare neoplasm in the mammary region. Fusiform and epithelioid cells arranged in concentric whorls in a myxoid tumor of soft tissue are a distinctive characteristic of this neoplasm and can suggest the diagnosis.     

Fine needle aspiration cytology and immunocytochemistry in tuberculous thyroiditis: a case report

BACKGROUND: Tuberculosis of the thyroid is very rare and does not strike the clinician as a first clinical diagnosis of a thyroid nodule. To our knowledge, only 40 cases of tuberculous thyroiditis diagnosed by fine needle aspiration cytology (FNAC) are described in the English literature. CASE: We report a case of tuberculous thyroiditis in a young woman who presented with a right-side solitary thyroid nodule of short duration (15 days), diagnosed by FNAC and confirmed by positive immunocytochemistry with monoclonal antibody to Mycobacterium tuberculosis complex. Ziehl Neelsen staining for acid-fast bacilli (AFB) was negative. CONCLUSION: FNAC provides a confident preoperative diagnosis of thyroid tuberculosis, obviating the need for unnecessary surgical removal of thyroid nodule. Immunocytochemistry is an important diagnostic adjunct to FNAC in AFB-negative cases.     

Fine needle aspiration cytology in a case of hepatoblastoma

The cytologic features of a case of hepatoblastoma diagnosed by fine needle aspiration (FNA) in an 18-month-old female infant are described. A mass detected in the left lobe of the liver on routine examination was subjected to FNA. The distinctive cytologic findings included malignant cells in small clusters and in acinar arrangements. Some of the acinar structures had bile plugs. Fat vacuoles were present within the cytoplasm of some of the malignant cells. Immature hematopoietic cells were also present.     

Fine needle aspiration cytology of low grade endometrial stromal sarcoma: a case report

BACKGROUND: Endometrial stromal sarcoma (ESS) is a rare neoplasm and is composed of E cells closely resembling normal proliferative endometrial stromal cells. Because of its rarity, the preoperative diagnosis is difficult for clinicians. These tumors are rarely subjected to fine needle aspiration (FNA), and the cytologic diagnosis is also difficult, as the differential diagnosis is leiomyosarcoma/cellular leiomyoma. CASE: A 23-year-old woman presented with a history of prolonged vaginal bleeding. The diagnosis on FNA was given as sarcoma with the possibility of low grade ESS or leiomyosarcoma. On histopathologic examination, the diagnosis was confirmed to be low grade ESS. CONCLUSION: Aspirates of low grade ESS are extremely cellular, with cohesive tissue fragments of monotonous, small, oval cells with bland chromatin tightly women in a metachromatic, extracellular matrix. The differential diagnosis should include a cellular leiomyoma and leiomyosarcoma.     

Fine needle aspiration cytology of metastatic lymphoepithelioma. A case report

A case is presented of lymphoepithelioma (undifferentiated nasopharyngeal carcinoma) metastatic to the cervical lymph nodes in a 12-year-old boy for whom material was obtained by fine needle aspiration (FNA) for the primary diagnosis as well as for ancillary studies. Papanicolaou-stained smears demonstrated the characteristic cytopathologic features of Regaud-type lymphoepithelioma; the diagnosis was substantiated by immunocytochemical and electron microscopic studies. This report discusses the reliability and rapidity of FNA in definitively diagnosing undifferentiated metastatic malignancies as well as providing superior material for ancillary studies demanded by lesions with complicated and difficult differential diagnoses.     

Fine needle aspiration cytology of intranodal myofibroblastoma. A case report

BACKGROUND: Intranodal myofibroblastoma is a rare, primitive, mesenchymal neoplasm of the lymph nodes first described in 1989. It behaves in a benign fashion and has a great predilection for the inguinal region. CASE REPORT: A 56-year-old man was referred for fine needle aspiration cytology of an inguinal lymph node. Smears were moderately cellular, with a predominant population of single, small spindle cells with no atypia. Most neoplastic cells were distributed as dissociated, single cells, with few groups. The cells showed metachromatic stromal material with a fibrillary quality. Nuclei were elongated, with pointed ends and occasional twisted forms. A remarkable finding on Papanicolaou-stained smears was hemosiderin granules. After a cytologic report of low grade spindle cell tumor, the node was excised, and a histologic and immunohistochemical diagnosis of intranodal myofibroblastoma was established. CONCLUSION: Intranodal myofibroblastoma should always be considered when aspirating solitary inguinal lymph nodes. The presence of a low grade spindle cell pattern of variably dissociated cells with hemosiderin granules should lead to immunocytochemical studies. Muscle-specific actin expression in the absence of S-100 protein and vascular markers permits a more specific diagnosis.