Crush cytology of Rosai-Dorfman disease of the central nervous system. A report of 2 cases

BACKGROUND: Rosai-Dorfman disease (RDD) of the central nervous system (CNS) is rare. There is no previous report on intraoperative crush cytology of this disorder. CASES: A 70-year-old man presented with headache and was found to have 2 intracranial extraaxial masses. A 62-year-old man presented with cauda equina syndrome secondary to a mass lesion in the sacral canal. The crush smears, prepared intraoperatively from a small portion of the biopsy specimen in each case, showed scattered lymphoid aggregates in a lighter background with a loose admixture of lymphocytes, plasma cells, usual histiocytes and RDD histiocytes. The RDD histiocytes contained single but sometimes multiple nuclei that were larger and more hyperchromatic than those of the usual histiocytes. Many RDD histiocytes had voluminous, pale pink cytoplasm. Lymphophagocytosis by RDD histiocytes was observed. The findings in the crush smears reflected the histology of the lesions. The lymphophagocytosis and nuclear details in the RDD histiocytes were more visible in the crush smears than in the frozen sections. CONCLUSION: Crush cytology appears useful, alone or in conjunction with frozen sections, in the intraoperative diagnosis of CNS RDD.     

Solitary fibrous tumor of the spinal cord. Report of a case with scrape cytology.

BACKGROUND: Solitary fibrous tumor is a rare spindle cell tumor and has been forced at a variety of sites. To the best of our knowledge, only two cases of solitary fibrous tumor arising in the spinal cord have been reported; no cytologic findings were documented. CASE: A 62-year-old male presented with a spinal cord tumor. A scrape smear of the resected tumor revealed naked, spindle-shaped nuclei. Some nuclei were twisted or had long spindles. In the background, abundant, thin and thick collagen fibers were present. Immunohistochemically, the spindle cells were positive for CD34 and negative for S-100 protein and alpha-smooth muscle actin. Histologic diagnosis of the tumor was benign solitary fibrous tumor. CONCLUSION: Our case indicates that solitary fibrous tumor can occur in the spinal cord and should be differentiated from other benign spindle cell tumors, such as meningioma and schwannoma. The key cytologic features of solitary fibrous tumor may be the presence of abundant thin and thick collagen fibers in scrape specimens.     

Aspiration cytology of heterotopic ossification. A case report.

Heterotopic ossification (myositis ossificans) is usually a posttraumatic reactive process involving new bone formation. This nonneoplastic process can be clinically and radiologically confused with osteosarcoma. A case of heterotopic ossification is reported in which cytologic material was obtained from a partially calcified thigh mass from a 17-year-old, athletic male. Aspiration cytology revealed numerous osteoclastic giant cells containing multiple plump nuclei. These cells were admixed in a benign-appearing stromal background composed of mature fibroblasts and were typified by elongated spindle cells. A small incisional biopsy showed new bone formation, osteoclasts, osteoblasts and fibroblasts consistent with maturing heterotopic ossification. Heterotopic ossification may be distinguished cytologically from osteosarcoma by the presence of numerous uniform benign stromal cells composed of mature fibroblasts and osteoclastic giant cells. The differential diagnosis may be more difficult in the early stages of this reactive and proliferative process. Adequate sampling of suspected heterotopic ossification by aspiration cytology may avoid surgery in a selected group of patients.     

Aspiration cytology of metastatic chordoma. A case report

A patient with previously diagnosed sacrococcygeal chordoma presented with multiple skin nodules. Cytologic examination of an aspirate from one of these nodules showed syncytial clusters of hyperchromatic cells surrounded by extracellular mucin. The characteristic physaliphorous cells, although present in a biopsy of the primary sacrococcygeal tumor, were not observed in the aspirate or on histopathologic examination of three excised skin metastases. That chordoma metastases may lack physaliphorous cells should be recognized.     

Sputum cytology in measles infection. A case report

A resurgence of measles, a highly infectious viral infection, has occurred in the United States. In this report the sputum cytology from a case of measles pneumonia is described and discussed. Only a few recent reports have described the cytopathologic changes of measles. Familiarity with the typical cytologic changes of measles will assist in the diagnosis of this infection.     

Exfoliative cytology of atypical polypoid adenomyoma. A case report.

BACKGROUND: An atypical polypoid adenomyoma (APA) is a well-defined entity. It occurs in the endometrium, lower uterine segment and endocervix. It is usually composed of atypical complex glands with squamous metaplasia admixed with myofibromatous stroma. CASE: A 35-year-old female presented with one-year history of irregular menstrual periods. A diagnosis of adenocarcinoma in situ was rendered on her cervicovaginal smear. Pelvic examination revealed an enlarged uterus due to a leiomyoma. Colposcopic examination revealed a 0.6-cm, sessile, polypoid mass at the junction of the endocervix and ectocervix. A cone biopsy of the lesion showed irregular, endometrial-type glands embedded in a prominent myofibromatous stroma. The atypical glandular component of the mass demonstrated varying degrees of architectural complexity, ranging from simple to complex hyperplasia. In tissue sections the lesion was diagnosed as APA of the cervix. The patient underwent a hysterectomy for the leiomyoma. The hysterectomy specimen showed an 8.5-cm leiomyoma. The cervix and uterine corpus revealed no residual APA. CONCLUSION: APA of the cervix should be considered among the differential diagnoses of atypical glandular cells of undetermined significance. The diagnosis of APA cannot be made on cytology; the final diagnosis requires histologic confirmation.     

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.     

Aspiration cytology of carcinoid tumor of the breast. A case report

A primary carcinoid breast tumor was evaluated by fine needle aspiration cytology in an 87-year-old female. The subsequent operative material contained a tumor with the typical histopathologic features of carcinoid tumors in other sites; thorough evaluation of the patient did not reveal carcinoid lesions elsewhere in the body. The tumor contained argyrophil-positive cytoplasmic granules on light microscopy. The cytomorphology of this tumor contains features helpful in identifying it on aspiration cytology material. The differential diagnosis with fine needle aspiration cytology of other breast tumors is discussed.     

Squash cytology of pleomorphic xanthoastrocytoma mimicking glioblastoma. A case report.

BACKGROUND: Pleomorphic xanthoastrocytoma (PXA) is an uncommon, superficially located and well-circumscribed brain tumor that originates in astrocytic cells. Despite the fact that the tumor cells are pleomorphic, with bizarre nuclei, the clinical course is favorable. Cytologic and histologic differentiation from other high grade gliomas is necessary to determine adequate therapy during surgery. Cytomorphologic features of this tumor have been described only rarely. CASE: A 22-year-old male had complained of visual disturbance for about a year. Radiologic imaging revealed a well-circumscribed mass with cyst formation in the left temporal area. Squash specimens from fresh tissues were highly cellular. Tumor cells were markedly pleomorphic, with long and coarse cytoplasmic processes showing a fibrillary astrocytic appearance. Pleomorphic cells varied in shape from round to elongated and had large, multilobed, hyperchromatic nuclei but few nuclear mitoses. Sometimes eosinophilic granular bodies were also observed. Blood vessels were found frequently in tumor cell clusters, but their endothelium was not swollen. In the background, considerable leukocytic infiltration, but no cellular debris, was observed. With immunohistochemical studies, most of the tumor cells were positive for glial fibrillary acidic protein and S-100 protein. Some of the mononuclear giant cells were positive for synaptophysin. CONCLUSION: Squash preparations showed the peculiar cytologic features of PXA. Together with the peculiar radiologic findings, the cytologic results make it possible to render a diagnosis of PXA.     

Fine needle aspiration cytology of adenomatoid tumor. A case report.

BACKGROUND: Adenomatoid tumor is a benign neoplasm of the male and female genital tract. The epididymis is the most common site. CASE: A 25-year-old male presented with a swelling in the left side of the epididymis. Cytology showed monotonous cells arranged in sheets, cords and glandular patterns. The cell showed eccentric vesicular nuclei with fine chromatin and abundant, vacuolated cytoplasm. CONCLUSION: With the help of fine needle aspiration cytology, an accurate diagnosis of adenomatoid tumor is possible and can relieve anxiety and uncertainty in both the patient and physician.     

Diagnosis of microfilaria in gastric brush cytology. A case report.

BACKGROUND: Filariasis due to Wuchereria bancrofti is endemic to southern Asia. While the laboratory diagnosis has been conventionally made by demonstrating microfilariae in peripheral blood smears, these have also been occasionally diagnosed on aspiration cytology of various organs. CASE: A 54-year-old male presented with a burning sensation in the epigastrium of five months' duration. Endoscopic brush biopsy revealed numerous sheathed microfilariae of W bancrofti. The patient had had no symptoms suggestive of filarial infection in the past. Cytology revealed numerous microfilariae among lymphocytes and neutrophils. CONCLUSION: This case illustrates that a thorough examination of gastric brushings can at times reveal unexpected findings and may prove to be a useful supplement to endoscopic biopsy.     

Endoscopic brushing cytology of primary gastric choriocarcinoma. A case report.

A rare primary choriocarcinoma of the stomach developed in a 71-year-old woman admitted with epigastric pain and weight loss. Brushing smears revealed highly atypical malignant cells with bizarre nuclei and prominent nucleoli. Multiple histologic sections revealed pure choriocarcinoma. Human chorionic gonadotropin and keratin were demonstrated in malignant cells by immunohistochemistry.     

Fine needle aspiration cytology of mesoblastic nephroma. A case report.

A case of congenital mesoblastic nephroma of the left kidney was diagnosed in a 4-month-old child by fine needle aspiration cytology. The smears consisted of clustered and dyshesive spindle cells with minimal nuclear atypia and mitosis. No epithelial, tubular or glomeruloid differentiation was noted. Considering the age and cytomorphology, a diagnosis of mesoblastic nephroma was made. Histopathology of the nephrectomy specimen showed a tumor with features of atypical mesoblastic nephroma. Cytologic diagnosis of mesoblastic nephroma is important because the tumor has an excellent prognosis, and unlike Wilms' tumor, requires only surgery.     

Aspiration biopsy cytology of secretory carcinoma of the breast. A case report.

Secretory carcinoma diagnosed by aspiration biopsy cytology (ABC) disclosed many characteristic figures that were similar to a bunch of grapes, secondary mucous globular structures (MGSs) and clustered MGSs. The MGS was a unit structure of secretory carcinoma composed of a centrally located, small amount of mucus and two or more tumor cells covering it. Other findings were vacuolated cells and mucus in a clear background. The presence of the above findings, especially the "bunch of grapes" and related forms, were though to be essential findings in the cytologic differential diagnosis of secretory carcinoma by the ABC method. The origin of the characteristic features is discussed.