Hyaline-cell pleomorphic adenoma. Diagnosis by fine needle aspiration biopsy

The cytologic, histologic, immunohistochemical and ultrastructural characteristics are presented of a case of hyaline-cell pleomorphic adenoma of the soft palate diagnosed by aspiration biopsy. Hyaline cells are commonly found in pleomorphic adenomas of minor salivary gland origin. The lack of cohesiveness of the hyaline cells makes them readily amenable to sampling by fine needle aspiration biopsy. When identified in a neoplasm, these cells are characteristic, and probably diagnostic, of a mixed tumor.     

Diagnosis of follicular lymphoma by fine needle aspiration biopsy.

This study evaluated the diagnostic accuracy of fine needle aspiration biopsy (FNAB) of follicular lymphoma (FL). Fourteen aspirates of lymph nodes in which follow-up surgical biopsy revealed FL were studied. Two aspirates were deemed unsatisfactory because of a paucity of cells. The remaining 12 cases received the following diagnoses: 4 positive for malignant lymphoma, 4 highly suspicious for malignant lymphoma and 4 false negatives. FNAB of FL can show a monomorphic or polymorphic cell population. The aspirates with a positive or suspicious diagnosis showed monomorphic cell populations. False-negative diagnoses were attributable to misleading sampling or preparation methods in most cases. We conclude that FNAB of FL is less accurate than FNAB of non-Hodgkin's malignant lymphoma (NHL) in general, but the accuracy rate is similar to that of FNAB of all low-grade NHL. The value of current approaches to the diagnosis of suspected lymphoma by FNAB is emphasized.     

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.     

Diagnosis of cervical chordoma by fine needle aspiration biopsy

A case of cervical chordoma diagnosed by fine needle aspiration (FNA) is presented. The cytologic criteria for differentiating chordoma from chondrosarcoma and metastatic adenocarcinoma, the main diagnostic problems, include the finding of physaliferous cells and the presence of bland nuclear features. Significantly, chordomas lack true signet-ring cells. FNA of these rare midline vertebral neoplasms, which produce pain and spinal cord compression, can greatly facilitate diagnosis and optimal treatment.     

Nodular pulmonary sarcoidosis. Diagnosis with fine needle aspiration biopsy

A case of sarcoidosis presenting as multiple pulmonary nodules and investigated by transthoracic fine needle aspiration biopsy is presented. Cohesive clusters of epithelial cells as well as multinucleated giant cells were observed. Special stains performed on the cell-block preparation were useful in ruling out an infectious etiology. The case demonstrates the value of fine needle aspiration biopsy in the investigation of pulmonary parenchymal disease and illustrates the cytologic findings in this unusual presentation of sarcoidosis.     

Transvaginal fine needle aspiration biopsy.

OBJECTIVE: To assess the role of transvaginal fine needle aspiration biopsy (FNAB) in the evaluation of palpable gynecologic masses. STUDY DESIGN: Transvaginal FNABs from 1994 to 1999 were identified from the files of Barnes-Jewish Hospital. Histologic correlation was obtained using the Pathology Department's computer database. Two pathologists reviewed the pathologic samples. Pertinent clinical information was obtained by reviewing the medical records. RESULTS: Twenty-two transvaginal FNABs from 22 patients were studied. The patients' mean age was 59 years (range, 29-84). Most patients (77%) had a previous history of a gynecologic malignancy, and 73% had a previous total abdominal hysterectomy and bilateral salpingo-oophorectomy. The size of the lesion sampled was provided in 15 cases and ranged from <1 to 5.4 cm in diameter. The location of the mass was reported as follows: vaginal (10 cases), vaginal cuff (5), rectovaginal septum (2), cul-de-sac (1), fornix (1), vaginal apex (1), right side of pelvis (1), and not specified (1). The cytologic diagnoses were: negative for malignancy (10 cases), positive for malignancy (9) and unsatisfactory (3). Most cases (77%) had histologic correlation or clinical follow-up. There was one false negative and no false positive cytologic diagnosis. CONCLUSION: Cytologic interpretation of transvaginal FNAB is an effective toolfor the evaluation of palpable pelvic and vaginal masses. Its specificity and sensitivity are 100% and 88%, respectively.     

Diagnosis of xanthogranulomatous cholecystitis by fine needle aspiration biopsy. A case report

Xanthogranulomatous cholecystitis is an uncommon benign thickening of the gallbladder wall characterized histopathologically by extensive histiocytic infiltration. A case is presented in which a 62-year-old woman with clinical cholecystitis was found at surgery to have a markedly thick-walled, adherent gallbladder, raising the differential diagnosis of an inflammatory versus an infiltrating neoplastic process. Intraoperative fine needle aspiration (FNA) biopsy revealed abundant foamy histiocytes ("xanthoma cells"), both dispersed and in clusters associated with capillaries suggestive of organization. Occasional multinucleated giant cells and columnar epithelial cells were also present. The differential diagnosis of histiocytic processes sampled by FNA biopsy is reviewed.     

Endoscopic fine needle aspiration biopsy

A catheter assembly that can be passed through the biopsy channel of a standard fiberoptic gastroduodenoscope was devised to permit fine needle aspiration biopsy of gastrointestinal neoplasms under direct vision of the endoscope. This technique for endoscopic aspiration biopsy was performed in ten consecutive patients with esophageal and gastric carcinomas, along with the conventional endoscopic brushing and biopsy. Endoscopic aspiration biopsy gave a positive diagnosis in all ten cases while the other two techniques gave inconclusive results in one patient with an ulcerative growth. We feel that endoscopic aspiration biopsy can be used to obtain representative samples from gastrointestinal neoplasms, and it may add to the diagnostic accuracy of endoscopic biopsy and brushing cytology.     

Diagnosis of radiolucent lesions of the jaw by fine needle aspiration biopsy

Radiolucent lesions of the jaw, representing a variety of metabolic, inflammatory, developmental, neoplastic and other disorders, may be quite variable in appearance. Fine needle aspiration biopsy, performed on 57 patients who presented with oral abnormalities, was used in an attempt to differentiate the pathologic processes in the 23 patients with radiolucent changes resulting from bony involvement. Most aspirations were performed on an outpatient basis, and the cytologic findings were correlated with the clinical course and subsequent surgical findings. The entities encountered included ameloblastoma, a variety of odontogenic cysts and inflammatory and infectious processes, such as actinomycosis and giant-cell and eosinophilic granulomas. An unusual salivary gland lesion was also observed. The aspiration biopsy proved to be a valuable adjunct method for the preoperative diagnosis of radiolucent lesions of the jaws. A discussion of the differential diagnostic considerations is presented.     

Diagnosis of thyroid metastasis of colonic adenocarcinoma by fine needle aspiration biopsy

A case of thyroid metastasis from colonic adenocarcinoma was diagnosed by fine needle aspiration (FNA) biopsy. The FNA specimen from the thyroid nodule contained tall columnar cells consistent with the intestinal primary. Staining of the tumor cells for thyroglobulin was negative. Histologic examination of the excised nodule, which was removed due to its rapid growth and risk of skin ulceration, confirmed the FNA diagnosis. FNA biopsy in such cases should be able to distinguish between a second primary neoplasm, which would be removed, and a metastasis, which would usually not be surgically treated.     

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.     

Pulmonary Hodgkin's disease. Diagnosis by fine needle aspiration

The cytologic manifestations of pulmonary Hodgkin's disease in transthoracic fine needle aspirates from 13 patients with pulmonary radiologic abnormalities and a previous diagnosis of Hodgkin's disease are described. Classic Reed-Sternberg cells and lacunar cells were present in most cases. The so-called "mononuclear" Reed-Sternberg cells were identified in all cases. A cellular background consisting of variable numbers of histiocytes, eosinophilic and neutrophilic leukocytes and lymphocytes was frequently present. Such a background should stimulate a search for cells diagnostic of Hodgkin's disease. We conclude that the cytologic features of Hodgkin's disease are not only characteristic, but are also diagnostic, in patients with a prior history of Hodgkin's disease in whom pulmonary recurrence is suspected.     

Cystosarcoma phyllodes. Diagnosis by fine needle aspiration cytology.

The cytologic features of 10 benign, 2 borderline and 5 malignant phyllodes tumors were studied, and an attempt was made to correlate the cytologic findings with corresponding histologic categories. Seventy-five percent of the benign and borderline tumors were interpreted as benign cystosarcoma phyllodes on fine needle aspiration cytology. Eighty percent of the malignant phyllodes tumors were identified as malignant lesions cytologically. The cytologic features assessed were the epithelial:stromal ratio and morphology of the stromal component, including the degree of atypia, mitotic activity, capillary vessels traversing the stromal fragments, presence of foamy macrophages, histiocytic giant cells and bipolar naked nuclei. A diagnosis of phyllodes tumor was suggested cytologically by the presence of both epithelial and stromal elements; the stroma was present as cellular "phyllodes fragments" and isolated mesenchymal cells. The parameters suggesting malignancy were extreme paucity or absence of epithelial elements and stromal cells in diffuse sheets and clusters less cohesive than normal, with marked stromal atypia and mitotic activity.     

Nodular fasciitis: diagnosis by fine needle aspiration biopsy

OBJECTIVE: To describe the cytomorphologic features of nodular fasciitis that differentiate it from schwannoma. STUDY DESIGN: The cytomorphologic features of 10 cases of nodular fasciitis were compared to those of 4 cases of biopsy-proven schwannoma. Aspirate smears were evaluated for cellular cohesion, cell type and stroma. Immunoperoxidase stains were utilized in select cases. RESULTS: The cases of nodular fasciitis exhibited cohesive clusters of epithelioid to spindle-shaped cells in a background of single, intact mesenchymal cells; inflammatory cells; and myxoid stroma. In contrast, schwannomas lacked single, intact cells and inflammation. Schwannoma stroma was also myxoid but appeared more finely fibrillar, and cell clusters were notable for alternating areas of hypercellularity and hypocellularity. Immunoperoxidase stains demonstrated smooth muscle actin reactivity in 5 cases of nodular fasciitis and S-100 in 2 cases of schwannoma. CONCLUSION: Nodular fasciitis can be distinguished from schwannomas on the basis of cytomorphologic features and immunocytochemical profile. Cytologic diagnosis of nodular fasciitis is important since it obviates the need for surgical excision.     

Kikuchi's histiocytic necrotizing lymphadenitis. Diagnosis by fine needle aspiration

Two cases of Kikuchi's histiocytic necrotizing lymphadenitis diagnosed by fine needle aspiration (FNA) of enlarged lymph nodes are reported. The FNA smears contained randomly activated lymphoid cells, necrotic debris, karyorrhectic cells and prominent histiocytes, suggesting the presence of reactive lymph nodes. The true nature of the lesions was evident from the examination of cell block sections prepared from tissue fragments in the aspirates, which preserved the architectural relationships of the different cell types. The same patterns were found in retrospectively and subsequently examined excised lymph nodes from these cases. The differential diagnosis of this entity, which may simulate a malignant lymphoma because of the presence of large numbers of activated lymphoid cells, is discussed and the value of preparing FNA cell blocks is emphasized. Though this rare benign disease may be suspected clinically in the more typical cases, such as young women with cervical lymphadenopathy, fever, neutropenia and otherwise excellent condition, the diagnosis cannot be made without a lymph node biopsy, which FNA may be able to provide in some instances.