Aspiration cytodiagnosis of the breast with abundant acellular calcific material indicative of soft tissue calcinosis (a study of 3 cases)

Calcific deposits in soft tissue are rare and may clinically resemble a tumour. It seems feasible, therefore, to investigate them by the non-invasive technique of fine needle aspiration cytology (FNAC). In this study three cases with extensive accumulation of acellular calcific material in the breast are described in which FNAC was indicative of soft tissue calcinosis. In all cases routine mammogram had shown a partially cystic opacity. All other investigations were normal and no significant family or medical history was present. Cytopreparations in all cases showed only abundant acellular calcium. The patients had no further treatment and on follow up were clinically well with no changes. The cases are interesting, since the cytohistological findings in the aspirate sample appeared to be strongly indicative of soft tissue calcinosis.     

Needle aspiration of the breast with immediate reporting of material.

Needle aspiration with immediate cytological reporting has been practised in a breast clinic for one year. Patients benefit by receiving immediately the provisional diagnosis and, when indicated, appointments for metastatic surveys. Close co-operation between surgeon and cytologist has resulted in increased skill in aspiration, better preparation of samples, and greater accuracy in interpretation of reports. Since 5% of clinically benign lesions have proved malignant, even on immediate reporting, we would recommend cytological examination of all breast lumps.     

Fine needle aspiration cytodiagnosis of secretory carcinoma of the breast

Secretory carcinoma (SC) of the breast is a rare variant of breast malignancy and its cytological features in fine needle aspirates have only recently been described. In this communication, our experience with four cases of SC of the breast is presented in which the diagnosis was established on fine needle aspiration cytology (FNAC). In all cases, the samples were cellular and featured diffuse, prominent, intracytoplasmic vacuoles and secretion in malignant cells and occasional signet-ring like forms. The cytodiagnosis of SC in all the cases correlated with subsequent examination of cell blocks of the aspirate and tissue. Cytochemical stains showed diffuse positivity for mucin by alcian blue stain in the vacuolated cells which was periodic acid-Schiff positive and resistant to diastase digestion. Oil-red O staining was negative. Immunopositivity to carcinoembryonic antigen, cytokeratin (CAM 5.2), B72.3 and epithelial membrane antigen was found in malignant cells. The cytodiagnostic criteria for SC of the breast, characteristic cytological features which are useful in a correct FNAC diagnosis and differentiation from other pertinent breast carcinomas, are discussed.     

Fine needle aspiration cytodiagnosis of clinically suspected tuberculosis in tissue enlargements

A retrospective study of the use of fine needle aspiration (FNA) cytology to confirm a clinical suspicion of tuberculosis in tissue enlargements was performed, using 70 cases. The criteria required to make an FNA cytodiagnosis of tuberculosis were reassessed, and the sensitivity and predictive value of cytology for diagnosing such aspirates was determined. All but 2 of the 70 aspirates contained adequate cellularity. The adequate samples were diagnosed as 40 cases of caseating tuberculosis, 11 cases of noncaseating tuberculosis and 17 cases of acute necrotizing granulomatous inflammation suspicious for tuberculosis. Subsequent histologic study verified the cytologic diagnosis in 27 of 27 biopsied caseating lesions, 4 of 7 biopsied noncaseating cases and 5 of 8 necrotizing cases. The six cases with a false-positive cytodiagnosis of tuberculosis were histologically diagnosed as one Lennert's lymphoma, two reactive lymph nodes and three necrotizing metastatic carcinomas. The sensitivity of FNA cytology for the diagnosis of tuberculosis was 100%, with the predictive value of a positive result being 88%. The findings in this study emphasize that all criteria for the diagnosis of tuberculosis in FNA samples must be utilized and that particular caution should be exercised in making a diagnosis of acute necrotizing tuberculosis.     

Fine needle aspiration cytodiagnosis of leiomyosarcoma of the breast. A case report

BACKGROUND: Leiomyosarcoma of the breast is a rare tumor. Here we present a case in an elderly female in which the diagnosis was suggested from an aspirate sample. CASE: An 80-year-old female presented with an irregular, firm mass in the left breast of a few months' duration. In view of the clinical suspicion of a tumor, fine needle aspiration was performed. It showed a large number of dissociated cells and compact sheets of spindly and round cells with pleomorphic, hyperchromatic and anaplastic nuclei; mitoses; nucleoli; and somewhat-vacuolated, eosinophilic cytoplasm. Examination of the cell block, tumor tissue and immunostaining further suggested the cytologic impression of a leiomyosarcoma. CONCLUSION: Although leiomyosarcoma of the breast is very rare, fine needle aspiration cytology may allow the diagnosis to be suggested. Correlation with cell block findings and the application of appropriate immunostains as an adjuvant to standard cytologic and histologic stains may allow a more confident diagnosis.     

Fine needle aspiration cytodiagnosis of sialadenitis with crystalloids.

OBJECTIVE: To assess the utility of fine needle aspiration cytology in the diagnosis of sialadenitis with crystalloid formation in four patients that presented with a swelling of the parotid gland. STUDY DESIGN: The swelling was aspirated in all the cases using a 22-gauge needle, and aspirates were submitted as needle and syringe washings in a cytology fixative (30% ethyl alcohol in physiologic saline). From these washings filter preparations were made on Sartorius or Gelman filters (pore size, 3 microns) and stained by the Papanicolaou method. Additionally, cell block preparations were made from the aspirate. After processing, sections were cut and stained by hematoxylin-eosin, Prussian blue, alcian blue, mucicarmine, and Von Kossa and congo red stain. No air-dried smears were made, and no electron microscopic studies were done. RESULTS: Stained cytologic preparations and cell blocks showed numerous nonbirefringent crystalloids of varying sizes and shapes appearing as rectangles, needles, squares and rods mixed with neutrophils and rare multinucleated giant cells. No salivary gland components were seen, and all special staining was negative. CONCLUSION: Fine needle aspiration cytology not only provided an accurate diagnosis of sialadenitis with crystalloids but also resulted in adopting conservative management and avoiding unnecessary surgery.     

Ultrasound-guided fine needle aspiration cytodiagnosis of leiomyosarcoma metastatic to the breast. A case report

BACKGROUND: Leiomyosarcomas are characterized by slow growth and late metastasis and most often involve the lung, liver and subcutaneous tissue. Metastasis to the breast is rare, with only four cases published in the English-language literature to date. Because of its rarity and the prolonged time interval between the diagnosis of the primary tumor and involvement of distant sites, accurate diagnosis of these tumors can be challenging. Evaluation of the cytomorphologic features of the tumor, ancillary immunocytochemical staining and detailed medical history of the patient are essential to making a correct diagnosis. CASE: A case of leiomyosarcoma metastatic to the breast occurred in a 60-year-old woman whose primary uterine leiomyosarcoma had been resected 10 years before the diagnosis of the metastasis. Fine needle aspiration performed with ultrasound guidance yielded a moderately cellular specimen composed of minimally pleomorphic spindle cells with smooth, blunt-ended nuclei arranged in an interlacing pattern. Immunocytochemical staining for muscle-specific actin confirmed the smooth muscle origin of the neoplasm. CONCLUSION: The results of cytomorphologic analysis and immunocytochemical staining performed after fine needle aspiration and the patient's history of primary uterine leiomyosarcoma allowed us to correctly diagnose metastasis to the breast and avoided inappropriate management of the metastasis as a primary tumor.     

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.     

Value of fine needle aspiration cytology of the breast, with an emphasis on the cytodiagnosis of colloid carcinoma.

The fine needle aspiration (FNA) cytologic evaluation of 6,941 lesions of the breast was reviewed, with an emphasis on the cytodiagnosis of colloid carcinoma. The most common benign breast diseases in this series were fibroadenomas, cysts and fibrocystic conditions. All cases with an FNA diagnosis of suspicious were biopsied; a number of these were found to be carcinoma of the breast. In cases with an FNA diagnosis of carcinoma of the breast, a plan of management was immediately adopted on the basis of that diagnosis. Thirteen cases of colloid (mucinous) carcinoma of the breast were diagnosed by FNA cytology; in all, the cytodiagnosis was confirmed by the subsequent histologic diagnosis. The distinctive cytologic criteria that may be useful for making an FNA diagnosis of colloid carcinoma of the breast are discussed, and the FNA differences between the pure and mixed types of colloid carcinoma are noted.     

The compressive material properties of the plantar soft tissue

The plantar soft tissue is the primary means of physical interaction between a person and the ground during locomotion. Dynamic loads greater than body weight are borne across the entire plantar surface during each step. However, most testing of these tissues has concentrated on the structural properties of the heel pad. The purpose of this study was to determine the material properties of the plantar soft tissue from six locations beneath: the great toe (subhallucal), the 1st, 3rd and 5th metatarsal heads (submetatarsal), the lateral midfoot (lateral submidfoot) and the heel (subcalcaneal). We obtained specimens from these locations from 11 young, non-diabetic donors; the tissue was cut into 2 cm x 2 cm blocks and the skin was removed. Stress relaxation experiments were conducted and the data were fit using the quasi-linear viscoelastic (QLV) theory. To determine tissue modulus, energy loss and the effect of test frequency, we also conducted displacement controlled triangle waves at five frequencies ranging from 0.005 to 10 Hz. The subcalcaneal tissue was found to have an increased relaxation time compared to the other areas. The subcalcaneal tissue was also found to have an increased modulus and decreased energy loss compared to the other areas. Across all areas, the modulus and energy loss increased for the 1 and 10 Hz tests compared to the other testing frequencies. This study is the first to generate material properties for all areas of the plantar soft tissue, demonstrating that the subcalcaneal tissue is different than the other plantar soft tissue areas. These data will have implications for foot computational modeling efforts and potentially for orthotic pressure reduction devices.     

Fine needle aspiration cytology of radiation-induced changes in nonneoplastic breast lesions. Possible pitfalls in cytodiagnosis

The range of radiation-induced changes in fine needle aspiration (FNA) smears of the breast is described. In 41 of more than 800 patients who underwent breast-conserving treatment, a palpable breast lesion developed, and FNA was performed. In six cases, a recurrent carcinoma was present. In the remaining cases, three patterns of nonneoplastic lesions could be discerned: epithelial atypia (14 cases), fat necrosis (10 cases) and poorly cellular smears without epithelial atypia or fat necrosis (13 cases). It is important to be familiar with the patterns of radiation-induced epithelial atypia, since such atypia may lead to a misdiagnosis of recurrent carcinoma. These atypical cells may show impressive anisocytosis and anisonucleosis; however, the nuclear/cytoplasmic ratio remains normal and an admixture of bipolar cells is present. Cell dissociation and necrotic cell debris, as often seen in breast cancer smears, were never encountered in FNA smears from radiated nonneoplastic breasts.     

Simulation of soft tissue failure using the material point method

Understanding the factors that control the extent of tissue damage as a result of material failure in soft tissues may provide means to improve diagnosis and treatment of soft tissue injuries. The objective of this research was to develop and test a computational framework for the study of the failure of anisotropic soft tissues subjected to finite deformation. An anisotropic constitutive model incorporating strain-based failure criteria was implemented in an existing computational solid mechanics software based on the material point method (MPM), a quasi-meshless particle method for simulations in computational mechanics. The constitutive model and the strain-based failure formulations were tested using simulations of simple shear and tensile mechanical tests. The model was then applied to investigate a scenario of a penetrating injury: a low-speed projectile was released through a myocardial material slab. Sensitivity studies were performed to establish the necessary grid resolution and time-step size. Results of the simple shear and tensile test simulations demonstrated the correct implementation of the constitutive model and the influence of both fiber family and matrix failure on predictions of overall tissue failure. The slab penetration simulations produced physically realistic wound tracts, exhibiting diameter increase from entrance to exit. Simulations examining the effect of bullet initial velocity showed that the anisotropy influenced the shape and size of the exit wound more at lower velocities. Furthermore, the size and taper of the wound cavity was smaller for the higher bullet velocity. It was concluded that these effects were due to the amount of momentum transfer. The results demonstrate the feasibility of using MPM and the associated failure model for large-scale numerical simulations of soft tissue failure.     

Fine needle aspiration diagnosis of cysticercosis in soft tissue swellings

The cytomorphologic criteria for diagnosing cysticercosis in fine needle aspirates are described. A retrospective analysis of aspirates from 62 cases with subcutaneous swellings in various sites showed the presence of the parasite in 25 cases. In another 31 cases, the aspiration smears contained no larval parts, but did contain an inflammatory reaction (consisting of large numbers of eosinophils and palasading histiocytes) suggestive of a parasitic cyst. Corresponding histologic material from 19 of these cases were diagnostic of cysticercosis in 9 cases and suggestive of cysticercosis in 10. However, histology was diagnostic of cysticercosis in six cases that produced acellular aspirates. These results show that fine needle aspiration cytology can diagnose or suggest cysticercosis in many cases, but may be falsely negative in a few.     

Sialadenitis with crystalloid formation. Fine needle aspiration cytodiagnosis of 15 cases

OBJECTIVE: To assess the utility of fine needle aspiration cytology in the diagnosis of sialadenitis with crystalloid formation. STUDY DESIGN: In 15 cases, salivary gland masses were aspirated using a disposable, 20-mL syringe and 25-gauge needles, maintaining negative pressure. Smears routinely were air dried and stained by Diff-Quik (Dade Behring AG, Düdingen, Germany). Occasionally smears were fixed in alcohol and stained by the Papanicolaou method. RESULTS: The smears showed large numbers of non-birefringent crystalloids of varying sizes and shapes. The crystalloids stained deep blue with Diff-Quik and bright orange with Papanicolaou stain. Multinucleated histiocytes, neutrophilic leukocytes and benign salivary gland parenchyma were found, also. CONCLUSION: Fine needle aspiration cytology provides an accurate diagnosis of sialadenitis with crystalloids and is useful for avoiding unnecessary surgery.     

Needle aspiration of the breast--why bother?

Needle aspiration biopsy for the examination of breast nodules is an accurate uncomplicated and rapid procedure. Of 1168 cases so examined, 127 were malignant with abnormal cells in 114. Case studies suggest that this procedure should be utilized in all palpable breast masses.     

Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours

Fine needle aspiration cytology (FNAC) is a widely accepted safe, simple and rapid diagnostic procedure used in the examination of neoplastic and non‐neoplastic lesions of various locations. Since its introduction, FNAC has developed into an effective diagnostic tool practiced in a large majority of medical centres evaluating and treating oncological patients. The role of FNAC has been limited in the examination of primary soft tissue lesions, however, as many physicians working in this area recommended against using FNAC. An increasing use of minimally invasive diagnostic procedures in the last decade has resulted in a better acceptance of FNAC as a first‐line approach or as a complementary tool to core needle biopsy in the diagnosis of musculoskeletal lesions. This review discusses the role and value of FNAC in the evaluation and treatment of soft tissue tumours based on the experience gathered over the course of 48 years at the Sarcoma Center in Lund, Sweden. FNAC reports most often provide diagnostic information allowing the initiation of treatment or, when definitive diagnosis cannot be rendered from a cytological examination, guiding the continued diagnostic investigation. The main advantages of soft tissue FNAC are good sensitivity and specificity, low morbidity, speed of diagnosis, and low cost/benefit ratio. The most important disadvantages stem from limited experience in cytological diagnosis of soft tissue tumours and a lack of standardised and uniform reporting system for soft tissue FNAC.