Fine needle aspiration cytology of primary pulmonary meningioma associated with minute meningotheliallike nodules. Report of a case with histologic,immunohistochemical and ultrastructural studies

BACKGROUND: Pulmonary meningioma is an unusual tumor located in the lung. Minute pulmonary meningotheliallike nodules are also uncommon tumor-like lesions found at the pleuropulmonary level as solitary or multiple nodules. The association of both entities is described in a recent report. CASE: A 58-year-old, male smoker without pathology underwent radiologic study before a surgical procedure. A peripheral nodule was found in the left lower lobe of the lung with benign characteristics. Fine needle aspiration cytology was performed under computed tomography guidance. Cytologic examination showed features of transitional meningioma and other lesions near the tumor. Minute pulmonary meningotheliallike nodules were also present. CONCLUSION: A diagnosis of meningioma should be considered when there is a combination of scanty material, whorls composed of concentrically arranged cells and isolated cells with intranuclear inclusions. The simultaneous presence of meningioma and meningotheliallike nodules corroborates the unifying hypothesis of their common origin and the nature of these rare pulmonary lesions.     

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.     

Mucinous tubular and spindle cell carcinoma of the kidney: Report of a case with imprint cytologic features

BACKGROUND: Mucinous tubular and spindle cell carcinoma of the kidney is a newly established subtype in the World Health Organization classification. The tumor has a good prognosis, and its diagnosis is clinically important. However, there are no reports of its cytologic features. Here we report the cytologic findings of this rare tumor. CASE: A 68-year-old female had left-sided abdominal pain, fatigue and hematuria. A large mass in the left kidney was removed. Histologically, the tumor was compatible with mucinous tubular and spindle cell carcinoma. Imprint cytologic examination revealed a large amount of tumor cells arranged in tubular, sheetlike and spindle structures. Some tumor cells showed clear cytoplasm. Nuclear atypia was mild, with occasional distinctive nucleoli. CONCLUSION: The cytologic features of mucinous tubular and spindle cell carcinoma have a varied appearance. It should be included in the differential diagnosis to avoid overtreatment.     

Cytologic features of ovarian granulosa cell tumor metastatic to the lung. A case report

BACKGROUND: Granulosa cell tumor (GCT) of the ovary is an uncommon but not rare tumor, and the adult type usually affects postmenopausal women. The adult type of GCT has several characteristic clinicopathologic features, including a composition of small, uniform cells with Call-Exner bodies and an ability to metastasize to extrapelvic organs, even several decades after the initial operation. CASE: A 62-year-old female was incidentally found to have multiple shadows in the peripheral portions of both lung fields on roentgenography. She had a past history of oophorectomy for an ovarian carcinoma more than 20 years earlier. A transbronchial lung biopsy series was nondiagnostic. An aspirate obtained by transthoracic fine needle aspiration (FNA) biopsy revealed clusters of rather uniform, small cells with nuclear grooves, suggestive of a metastatic lung tumor. Histologic examination of the lung tissue in comparison with the previous oophorectomy specimen confirmed the impression of GCT metastatic to the lung. CONCLUSION: A preoperative diagnosis of metastatic lung tumor was established by transthoracic FNA cytology. The important cytologic criteria for the differential diagnosis are uniformity of tumor cells, coffee bean-like nuclear grooves and Call-Exner bodies. The possibility of late recurrence of this kind of tumor, even two or three decades after surgical resection, should be kept in mind.     

Cytologic diagnosis of alveolar soft part sarcoma of the lower extremity by fine needle aspiration and correlation with core biopsy: a case report

BACKGROUND: Alveolar soft part sarcoma is a rare soft tissue tumor of uncertain origin that is generally slow growing but unmistakably malignant due to its propensity for metastasis to lung, bone and brain early in the course of disease. Fine needle aspiration biopsy (FNAB) of these tumors and recognition of the characteristic cytologic features precludes more invasive diagnostic measures and facilitates appropriate treatment. CASE: A 54-year-old African-American man presented to our institution with a 2-week history of left leg pain. Imaging studies revealed a left leg soft tissue mass just below the popliteal fossa and multiple bilateral lung lesions suggestive of metastatic neoplasm. FNAB of the left lower extremity mass yielded uniform clusters of cells and sigle cells with large nuclei and single prominent nucleoli. Histologically, the biopsy showed nests of large polygonal cells with abundant eosinophilic cytoplasm, round regular nuclei and prominent nucleoli. A periodic acid-Schiff (PAS) stain highlighted intracytoplasmic rhomboidal crystals, a feature diagnostic of alveolar soft part sarcoma. CONCLUSION: Alveolar soft part sarcoma may be diagnosed by its unique morphologic characteristics and should be considered in the differential diagnosis of all cytologically sampled soft tissue lesions.     

Fine needle aspiration cytology of metastatic choriocarcinoma presenting as a breast lump. A case report

BACKGROUND: While choriocarcinoma is a rapidly invasive, widely metastasizing malignancy, it responds well to chemotherapy, so it is important to obtain an early diagnosis. We report the fine needle aspiration cytology (FNAC) of a case of choriocarcinoma metastatic to the breast. CASE: A 48-year-old female presented with a cough, hemoptysis and epistaxis. Chest computed tomography revealed multiple nodules in both lung fields. Also, a firm, slightly tender mass in the lower outer quadrant of the left breast was palpated. The breast mass was clinically suspected to be a metastatic lung cancer. FNAC of the breast showed a malignant tumor that had been misdiagnosed as a metastatic non-small cell carcinoma of the lung. Histologic examination of a nasal biopsy revealed metastatic choriocarcinoma. CONCLUSION: The cytologic features of choriocarcinoma are quite characteristic, with side-by-side, malignant, mononucleated cells and multinucleated giant cells corresponding to cytotrophoblasts and syncytiotrophoblasts, respectively. The disease is possible to diagnose by a careful examination of FNAC samples.     

Cytologic characteristics of pulmonary papillary adenoma. A case report

BACKGROUND: Pulmonary papillary adenoma is a benign pulmonary neoplasm. Previously pulmonary papillary adenoma was described in terms of immunohistochemistry and ultrastructure. However, there are no previous reports describing the cytologic characteristics of pulmonary papillary adenoma. CASE: A 50-year-old male was admitted for evaluation of a coin lesion in the left upper lung field. Radiologic images showed a solid, round tumor approximately 25 mm in diameter in the left upper lung. Transbronchial needle aspiration biopsy (TBNA) was performed, and small numbers of atypical cells were collected. Adenocarcinoma was suggested clinically, and left upper segmentectomy was performed. The histologic diagnosis was pulmonary papillary adenoma. Imprint cytology of the cut surface of the tumor showed tumor cells arranged in sheets that contained scant or vesicular cytoplasm. The nuclei were oval or round, without obvious anisokaryosis, and their chromatin was fine, without hyperchromasia. Cytologically, the nuclei of the tumor cells in the imprint specimen (38.70 +/- 8.69 microns 2) were uniform in size and similar to the atypical cells in the TBNA specimen (38.29 +/- 11.56 microns 2) but significantly larger than the nuclei of the bronchial cells (23.61 +/- 5.98 microns 2) (P < .0001). CONCLUSION: The cytologic appearance of pulmonary papillary adenoma was characterized morphologically and morphometrically. The possibility of cytodiagnosis by TBNA was suggested.     

Osteoclastomalike giant cell tumor of the parotid gland: report of a case with fine needle aspiration diagnosis

BACKGROUND: Osteoclastomalike giant cell tumor of the parotid gland has been reported rarely. The tumor has occurred rarely at many sites, such as thyroid, pancreas, soft tissue, breast, skin, heart, colon, lung, kidney, ovary and bladder. The exact origin of the tumor is unclear. However, osteoclastlike giant cells have been considered either part of a stromal process reactive to a neoplasm or a component of a primary neoplasm. CASE: A 35-year-old female presented with a mass in the left parotid gland clinically diagnosed as a pleomorphic adenoma. Fine needle aspiration (FNA) was advised before surgical excision. FNA smears revealed numerous osteoclastlike, multinucleated giant cells and many malignant-looking mononuclear cells. The smears were diagnosed as positive for malignancy, suggestive of osteoclastomalike giant cell tumor. The tumor was excised, and histopathologic study confirmed the cytologic diagnosis. CONCLUSION: The cytologic findings of osteoclastomalike giant cell tumor of the parotid gland have not been previously reported. FNA aided the diagnosis and planning of treatment. FNA is important in the diagnosis of parotid tumors.     

Exfoliative cytology of a lymphoepithelioma-like carcinoma in a cervical smear. A case report

BACKGROUND: Lymphoepithelioma-like carcinoma of the cervix (LELC) is cytologically identical to its counterparts at other sites, such as the nasopharynx. LELC can be suspected on a cervical cytologic smear. The differential diagnosis includes nonkeratinizing squamous cell carcinoma with prominent stromal inflammation, carcinoma with intense stromal eosinophilia, glassy cell carcinoma, malignant lymphoma (especially lymphoepitheloid-Lennerts lymphoma) and metastatic Schmincke-Regaud tumor. CASE: A 55-year-old female presented with an ulcerated endophytic tumor in the cervix. Exfoliative cytology showed uniform, large tumor cells, often associated with inflammatory cells, with round or oval nuclei and one or more prominent nucleoli. The cytoplasm was finely granular to flocculent, and the nuclei were uniformly vesicular. The chromatin was peripherally marginated. The cell borders were indistinct. There was no evidence of dyskeratotic or keratinized cells, koilocytes or glandlike formations. These findings were highly suspicious for LELC and were confirmed by biopsy. Flow cytometry showed DNA aneuploidy, with a DNA index of 1.08. In situ hybridization was negative for human papillomavirus 16 and 18. CONCLUSION: LELC of the uterine cervix has cytologic features that are sufficiently characteristic for a specific cytologic diagnosis. The diagnosis, nevertheless, has to be proven by histology.     

Cytopathologic and clinicopathologic features of ovarian hepatoid carcinoma. A case report

BACKGROUND: Hepatoid carcinoma is a rare ovarian tumor and is thought to be a different histopathologic subtype from hepatoid-type yolk sac tumor based upon its pathologic features. However, the cytopathologic characteristics of ovarian hepatoid carcinoma (OHC) have not been reported previously. We report the clinicopathologic and cytopathologic features and immunoreactivity of a case of OHC. CASE: A 36-year-old woman presented to our department with lower abdominal pain. A left ovarian tumor was found on pelvic examination, magnetic resonance imaging and computed tomography. The tumor was diagnosed as a hepatoid carcinoma of the left ovary based upon the histopathology of the surgically resected specimen. Cytopathologic specimens from a tumor touch preparation of the tumor exhibited pleomorphic tumor cells with abundant cytoplasm. The nuclei contained rough, granular chromatin and large, prominent nucleoli. Several tumor cells were multinucleated. Tumor cells were immunoreactive for alpha-fetoprotein (AFP). Hematoxylin and eosin staining revealed that the tumor cells were in a sinusoidal pattern resembling hepatocellular carcinoma without any glandular formation. The tumor cells were negative for human chorionic gonadotropin while positive for AFP, alpha-1-antitripsin, CA-125 and carcinoembryonic antigen. CONCLUSION: Cytopathologic examination is of considerable aid in the diagnosis of OHC since cytopathologic preparations highlight the characteristic cell pleomorphism.     

痰液脱落细胞中p16 基因和RASSF1A 基因甲基化与周边型非小细胞 肺癌关系的研究

目的:探讨p16基因和RASSF1A基因甲基化与肺癌发生发展的关系和应用于诊断的意义。方法:采用甲基化特异性PCR(Methylation Specific PCR,MSP)检测120例周边型非小细胞肺癌患者癌组织、痰液脱落细胞和120例非肺癌人群的痰液脱落细胞中p16基因和RASSF1A基因甲基化,分析它们与临床特征的关系以及非肺癌人群与肿瘤患者之间的差异。结果:(1)120例周边型非小细胞肺癌组织中,p16基因甲基化率46.7%(56例),RASSF1A基因甲基化率53.3%(64例)。P16和RASSF1A基因甲基化与吸烟程度、肿瘤大小和临床分期正相关(P<0.05)。(2)肺癌痰液脱落细胞中有28例p16基因出现甲基化(23.3%),20例RASSF1A基因出现甲基化(16.7%),其中32例至少存在一个基因的甲基化(26.7%);66例重度吸烟者中只有4例痰液脱落细胞出现p16基因甲基化(6%),4例出现RASSF1A基因甲基化(6%);54例非重度吸烟正常人中仅有2例出现p16基因甲基化(3.7%),RASSF1A基因无甲基化。(3)液基痰细胞病理学检查与痰脱落细胞p16和RASSF1a基因甲基化检测结合起来可有效提高诊断的灵敏度(P<0.05)。结论:烟草可能具有潜在的诱导抑癌基因p16和RASSF1A发生甲基化的作用;p16和RASSF1A基因甲基化可能参与肺癌的生长过程。痰脱落细胞p16和RASSF1a基因甲基化检测结合液基痰细胞病理学诊断,可提高非小细胞肺癌诊断的灵敏度。     

Multifocal Langerhans cell sarcoma involving epidermis:a case report and review

ABSTRACT: OBJECTIVE: To study the clinico-pathological characteristics of Langerhans cell sarcoma (LCS) which involving epidermis. METHODS: A case of primary multifocal LCS was analyzed in histopathology and immunophenotype. RESULTS: A 41-year-old man with multifocal cutaneous LCS involving the inguina and waist was reported. Clinical and pathology data were available. Neoplastic cells with markedly malignant cytological features were observed. Tumor cells exhibited irregular shape with abundant and eosinophilic red staining cytoplasm; large, irregular-shaped, showing lobulated or dented nucleus and some cells with a longitudinal nuclear groove and prominent nucleoli. The tumor cells expressed CD1a, Langerin (CD207), S-100 protein, CD68 and vimentin, and did not express pan-T or B cell markers and epithelial markers. The patient died less than 1 year after diagnosis due to local recurrence and metastasis to the lung, despite the administration of local radiation and chemotherapy. CONCLUSIONS: LCS is a tumor with markedly malignant cytological features that originates from Langerhans cells. Primary multifocal neoplasms involving epidermis is even rare. Accurate diagnosis is based on the histopathological and immunohistochemical of the tumor cells.Virtual slideThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1182345104754765.     

Aspiration biopsy cytology of benign clear cell ("sugar") tumor of the lung

Benign clear cell tumor (BCCT) of the lung is an uncommon neoplasm, with about 24 cases reported in the literature. A fine needle aspirate from a histologically and ultrastructurally confirmed BCCT of the lung contained large irregular clusters of polygonal and spindle-shaped benign-appearing cells with vacuolated, granular, periodic-acid-Schiff-positive cytoplasm. Cytologic study of the aspirate suggested a pseudoinflammatory tumor; however, a metastatic renal cell tumor or a primary clear cell or mesenchymal tumor could not be excluded. The histologic, ultrastructural and cytochemical findings are also presented, and the cytologic differential diagnosis of this neoplasm is briefly discussed.     

Cytopathology of oncocytic carcinoid tumor of the lung mimicking granular cell tumor. A case report

BACKGROUND: The cytopathologic features of oncocytic carcinoid tumor of the lung, a rare variant of carcinoid tumor that is composed exclusively of oncocytes, have not been described before in detail. CASE: The bronchial brush smears from an 80-year-old female with an endobronchial obstructive tumor showed single and loose clusters of tumor cells with abundant granular, eosinophilic cytoplasm. The differential diagnoses included oncocytic carcinoid tumor, granular cell tumor, other oncocytic tumors of bronchial origin and metastatic oncocytic tumors. Immunocytochemistry and electron microscopy confirmed the diagnosis of oncocytic carcinoid tumor. CONCLUSION: Oncocytic carcinoid tumor of the lung has cytopathologic features similar to those of granular cell tumor and pulmonary oncocytoma. Immunocytochemistry, electron microscope or both are necessary to distinguish these neoplasms.     

Cytologic features of pulmonary hamartoma. Report of a case diagnosed by fine needle aspiration cytology

BACKGROUND: Pulmonary hamartoma (PH) is the most common benign tumor of the lung. It is usually composed of cartilage, fat, smooth muscle and respiratory epithelium. Its diagnosis is based on imaging methods (radiography, computed tomography) and cytohistomorphologic study by means of fine needle aspiration cytology (FNAC). CASE: A 59-year-old female had a productive cough and lung mass on chest radiography. Fine needle aspiration of the nodule showed a fusiform tumor cell, which was diagnosed as consistent with PH. The patient underwent surgery for the tumor. Histopathologic study confirmed the diagnosis of PH. CONCLUSION: The fluoroscopically guided FNAC specimen was adequate in achieving a diagnosis. Cytologic features consisted of a serosanguineous background in which scant cellular elements of spindle and stellate cells, as well as fibromyxoid material, enabled us to make a definitive diagnosis. Since this technique is relatively noninvasive, it is very useful in diagnosing PH before a preoperative biopsy.     

Combined morphometrical and syntactic structure analysis as tools for histomorphological insight into human lung carcinoma growth

Histological sections of formalin-fixed, paraffin-embedded tissue comprising 60 surgical specimens of human lung carcinoma were Feulgen stained. The histomorphological images were transferred to an automated image analysing system (VISIAC) and analysed as follows. The geometrical centers of tumor cell nuclei were defined as vertices, and the minimum spanning tree (MST) was calculated based on the two-dimensional distance between the vertices. Segmentation of the images was performed semiautomatically by interactive definition of nuclei of interest and automated detection of nuclear boundaries. Several morphometric features of tumor cell nuclei were measured including size, DNA-content (extinction), and form factor, and were set in relation to parameters of the MST. The following results were obtained: DNA-content and tumor cell nucleus size ('center cell') of different microscopic tumor growth patterns are related to the number of nearest neighboring cells. No relation was found in the neighboring (surrounding) cells. The different cell types of lung carcinoma, i.e., the different microscopic tumor textures expressed the relation of center cell features to the parameters of MST. A high amount of DNA content in branching points of the MST for epidermoid carcinoma may be interpreted as carcinoma growing in epidermoid textures tend to proliferate from tumor cell nuclei related to at least one neighboring cell. The opposite was found for large cell anaplastic carcinoma (no perceptible microscopic textures of the tumors) which showed the highest DNA content in tumor cell nuclei but which was not related to any neighboring cells. This technique allows analysis of growth centers and microenvironment conditions in human lung cancer in relation to tumor texture at the light microscopy level.     

Peripheral calcifying cystic odontogenic tumour of the maxillary gingiva

ABSTRACT: BACKGROUND: Odontogenic tumors are lesions that are derived from remnants of the components of the developing tooth germ. The calcifying cystic odontogenic tumor or calcifying odontogenic cyst is a benign cystic neoplasm of odontogenic origin that is characterized by an ameloblastoma-like epithelium. Calcifying cystic odontogenic tumor may be centrally or peripherally located, and its ghost cells may exhibit calcification, as first described by Gorlin in 1962. Most peripheral calcifying cystic odontogenic tumors are located in the anterior gingiva of the mandible or maxilla. CASE PRESENTATION: Authors report a rare case of a peripheral calcifying cystic odontogenic tumor of the maxillary gingiva. A 39-year-old male patient presented with a fibrous mass on the attached buccal gingiva of the upper left cuspid teeth. It was 0.7-cm-diameter, painless and it was clinically diagnosed as a peripheral ossifying fibroma. After an excisional biopsy, the diagnosis was peripheric calcifying cystic odontogenic tumor. The patient was monitored for five years following the excision, and no recurrence was detected. CONCLUSIONS: All biopsy material must be sent for histological examination. If the histological examination of gingival lesions with innocuous appearance is not performed, the frequency of peripheral calcifying cystic odontogenic tumor and other peripheral odontogenic tumors may be underestimated.     

X线片和多层螺旋CT诊断及鉴别周围型肺癌的对比研究

目的:对比X线平片和多层螺旋CT诊断及鉴别周围型肺癌的效果。方法:选取了100例周围型肺癌患者,所有患者入院后先行X线片检查,后进行多层螺旋CT检查。通过观察并记录X线片与多层螺旋CT对周围型肺癌的影像学特征、临床TNM分期的诊断效果,评价X线平片和多层螺旋CT对周围型肺癌的诊断效果。结果:多层螺旋CT对周围型肺癌的肿块、分叶征、支气管气象征、空洞、胸膜凹陷、血管集束征,胸腔积液的检出率均高于X线片(P0.05)。根据外科病理TNM分期结果,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率为92.0%,X线对周围型肺癌的临床TNM分期诊断符合率为61.0%,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率明显高于X线(P0.05)。结论:多层螺旋CT对于周围型肺癌各类型影像学征象具有较好的检出率,对周围型肺癌临床TNM分期诊断准确性接近病理诊断结果。     

Fine needle aspiration biopsy features with histologic correlation in mediastinal hepatoid yolk sac tumor presenting with sternum metastasis: a case report

BACKGROUND: The hepatoid variant of yolk sac tumor (H-YST) is an exceedingly rare and highly malignant neoplasm. We present and discuss our experience with cytologic and histopathologic features of a mediastinal H-YST presenting with sternum metastasis, which to the best of our knowledge has not been previously reported. CASE: A 38-year-old man presented with a large mass on the sternum. Computed tomography of the thorax showed a large anterior mediastinal mass with sternum metastsis and multiple lung metastases. Laboratory examination revealed elevated serum alpha-fetoprotein (60,000 IU/mL). No tumor was found in the other organ systems. A percutaneous fine needle aspiration biopsy and subsequent open surgical biopsy were performed on the sternum metastasis. Cytologically, the tumor was composed of monotonous, large, round to polygonal hepatoid cells forming solid sheets and trabeculae entrapped with endothelial cells resembling hepatocellular carcinoma. Histopathologic sections of tumor showed tumor cells with eosinophilic to clear cytoplasm arranged in a solid, trabecular growth pattern, with some acinar formations. Immunohistochemical study supported the hepatoid origin. CONCLUSION: Fine needle aspiration cytology, together with the characteristic clinical presentations and specific tumor markers, is crucial to the initial diagnosis of H-YST.