Oropharyngeal chordoma diagnosed by fine needle aspiration: a case report

BACKGROUND: Due to its rarity, chordoma may be difficult to differentiate from other neoplasms with a similiar myxoid background. We describe a case of chordoma involving the oropharynx inferiorly that was diagnosed by transoral fine needle aspiration (FNA) cytology (FNAC) and confirmed by histologic studies. This appears to be 1 of the few reported applications of FNA in the diagnosis of chordoma of the oropharynx in the English-language literature. CASE: A 50-year-old male presented with nocturnal dyspnea and rare hemoptysis for 6 months. A hypodense mass was located in the left posterior side of the oropharynx. FNAC of the mass showed classic physaliferous cells with a bubbly appearance and myxoid fibrillary background. The aspirate was reported as "myxoid tumor suggestive of chordoma," as confirmed by histopathologic investigation of the excisional biopsy. CONCLUSION: The cytologic features of chordoma are quite characteristic, especially on May-Grünwald-Giemsa (MGG)-stained slides. The cytoplasmic vacuoles of the physaliferous cells and the mucoid matrix of the tumor become conspicuous on MGG staining. When Papanicolaou staining is used as the only staining procedure, the cytoplasmic vacuoles of the physaliferous cells and mucoid matrix of chordomas may be overlooked. The differential diagnosis of myxoid tumors is of utmost importance for therapy and prognosis.     

Fine needle aspiration cytology of desmoplastic malignant melanoma. A case report

The cytologic features of a recurrent desmoplastic malignant melanoma (DMM) examined by fine needle aspiration biopsy are reported. Cytologic examination revealed multiple microtissue fragments as well as smaller, dissociative aggregates composed predominantly of spindle-shaped neoplastic cells with hyperchromatic nuclei, small but prominent nucleoli and no cytoplasmic pigment or intranuclear pseudoinclusions. The tumor cells exhibited weak cytoplasmic staining for S-100 protein. To the best of our knowledge, this is the first reported case report describing the cytologic findings of DMM. Problems in differential diagnosis are discussed.     

Fine needle aspiration biopsy of myxoid metastasis of malignant melanoma

The cytopathologic features of the fine needle aspiration biopsy of a myxoid metastasis of a cutaneous malignant melanoma are documented. The cytologic findings included fusiform-to-round cells with elongated cytoplasmic processes, fibroblastlike cells and inflammatory cells in a characteristic amorphous background substance. Immunocytochemical staining for S-100 protein was positive. The cytologic findings correlated well the histologic, histochemical, immunohistochemical and ultrastructural studies of the neoplasm. The cytologic differential diagnosis between metastases of malignant melanoma and other myxoid tumors of soft tissues is discussed.     

Epithelioid hemangioendothelioma of the lung diagnosed by transesophageal endoscopic ultrasound-guided fine needle aspiration: a case report

BACKGROUND: Epithelioid hemangioendothelioma is a rare vascular tumor of the lung and is also known as intravascular sclerosing bronchoalveolar tumor. Although it has relatively low malignant potential, extensive pulmonary involvement and systemic metastasis have been described. The cytologic features of these tumors are not very well defined, with only few case reports describing the cytologic findings of epithelioid hemangioendothelioma of the lung on fine needle aspiration. CASE: Endoscopic ultrasound-guided fine needle aspiration of a hilar mass was performed on a 25-year-old female. The cytology showed loosely cohesive sheets and clusters of epithelioid cells. The cellular features included large, irregular nuclei with nucleoli and a moderate amount of vacuolated cytoplasm. Rare cells had a suggestion of cytoplasmic lumen formation. Histologic examination of tissue fragments on the cell block revealed a tumor composed of rounded to spindled epithelioid cells in a background of light blue stroma. The endothelial differentiation was evidenced by cytoplasmic vacuoles and lumens, some of which contained erythrocytes. The endothelial nature of these cells was confirmed by positive staining with factor VIII and CD34. CONCLUSION: The cytomorphologic features of epithelioid hemangioendothelioma described in the literature and observed in our case are distinctive and can help with the interpretation of cytologic smears and prevent misdiagnosis.     

Morphologic spectrum of hepatocellular carcinoma in fine needle aspiration biopsies

The light microscopic features of fine needle aspiration smears from 52 primary hepatocellular carcinomas were reviewed. Cytologic grading of these tumors, which indicated three grade I, 29 grade II and 20 grade III carcinomas, was compatible with grading done by histologic examination. In addition to the general cellular characteristics, other cytologic features observed in the smears included bile (48% of the cases), large cytoplasmic vacuoles (23%), small cytoplasmic vacuoles (46%), eosinophilic cytoplasmic inclusions (8%), basophilic cytoplasmic inclusions (48%) and intranuclear cytoplasmic inclusions (71%). The significance of these features is briefly discussed.     

Extradural spinal meningioma as a source of plasmacytoid cells. A case report

BACKGROUND: Meningiomas, tumors that often affect middle-aged and elderly people, occasionally arise in the spine, typically at the thoracic level. The cytologic findings in meningiomas include whorls and syncytial clusters of bland-looking cells with scattered, psammomatous calcifications and intranudclear cytoplasmic inclusions. However, in many cases, not all these findings are seen, and in rare cases, unusual cytomorphologic features are observed. CASE: A case of spinal meningioma was located in the extradural compartment and composed predominantly of singly scattered cells with a plasmacytoid appearance, demonstrated on fine needle aspiration biopsy smear preparations. The cell block showed more typical features of meningioma, and the diagnosis was supported by the results of immunohistochemical staining. CONCLUSION: The diagnosis of spinal meningioma is readily made by employing magnetic resonance imaging. The diagnosis can be difficult to confirm pathologically when atypical histologic findings are present, as in this case, with prominent plasmacytoid features. Sections from the cell block and immunohistochemical stains as well as clinical and radiologic findings were extremely helpful in arriving at the final diagnosis.     

Old and new immunohistochemical markers for the diagnosis of gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are generally CD117-positive and KIT or PDGFRA mutation-driven mesenchymal tumors of the gastrointestinal tract, probably originating in interstitial cells of Cajal or related precursors. CD117 is the best diagnostic marker for GISTs, but 5-10% are negative. Staining pattern may be cytoplasmic, membrane, and paranuclear (Golgi pattern). PDGFRA expression can be located in the cytoplasm, membrane, and paranuclear region (Golgi pattern), but the lack of specificity, ubiquity of the staining, and technical problems have pushed it a second plane. In GISTs, the staining pattern of PKCO is cytoplasmic, diffuse, and granular, although a Golgi pattern may be seen. Global expression varies. The staining pattern of DOG1 varies from cytoplasmic to membranous, with usually strong, diffuse intensity. The positivity rate is almost identical in some series to CD117 positivity. Currently, it is considered the most specific and sensitive marker for GIST. The current panel for GIST includes CD117, smooth muscle actin, CD34, desmin, and S-100. Some authors also include PDGFRA, PKC0, and DOG1. The last two can be of value in a subset of GISTs, mainly in CD117-negative cases.     

Role of c-kit/SCF in cause and treatment of gastrointestinal stromal tumors (GIST)

c-Kit encodes for the receptor tyrosine kinase (RTK) and belongs to type III receptor family. This includes platelet derived growth factor (PDGF) alpha and beta and macrophage colony stimulating factor (mCSF) apart from others. Their characteristic features are the presence of five immunologlobulin like domains in the extracellular region and 70-100 residues long kinase insert domain in the cytoplasmic region. The RTKs activate several signaling pathways within the cells leading to cell proliferation, differentiation, migration or metabolic changes. The Kit ligand-stem cell factor (SCF) induces a rapid and complete receptor dimerization resulting in activation by autophosphorylation of the catalytic tyrosine kinase and generation of signal transduction leading to regulation of cell growth. Various mutations in c-kit such as insertions and deletions (without affecting reading frame) and point mutations in the inhibitory juxtamembrane (JM) domain encoded by exon 11 have been reported in gastrointestinal stromal tumors (GISTs). Thus, c-kit signaling is believed to play a role in tumorigenesis. Efforts are being made to control and treat these tumors by blocking kit signaling using Imatinib with varying degrees of success. This review deals with the features of c-kit, its ligand and roles in gastrointestinal stromal tumors.     

Unmasking of Proteins by in Vitro Methylation of Rat Liver Rna During Azo Dye Carcinogenesis

In liver parenchyma of rats fed the azo dye 4-dimethylaminoazobenzene cytoplasmic ribonucleic acid (RNA) stains intensely with toluidine blue in sites of neoplastic transformation and hepatomas. With the mercury-bromphenol blue method, the staining intensity of proteins was found to be much weaker in these areas than in surrounding tissue. A 4 hr treatment at 60 C in a mixture of methanol and HCI completely abolished the increased staining of RNA with toluidine blue, but restored protein stainability with bromphenol blue in preneoplastic foci and tumors; the staining intensity of proteins was then comparable to that in surrounding liver. These results suggest that proteins were masked by the RNA responsible for hyperbasophilia, and that in vitro addition of methyl groups to such RNA is equal in effect to RNase extraction which was previously found to unmask cytoplasmic proteins.     

Expression of antiapoptotic protein survivin in malignant melanoma

We examined the expression of potential tumor marker survivin by immunohistochemical staining using antisurvivin antibody (DAKO, Clone 12C4) in a panel of 25 malignant melanomas. In each section, we assessed the percentage of positively stained tumor cells, the intensity of staining and its subcellular localization. Survivin was present in 23 out of 25 cases (92%). Nuclear staining was found in 2 of these 23 cases (8.7%) only, while cytoplasmic staining only was seen in 3 of them (13%). The combined nuclear as well as cytoplasmic localization of survivin was demonstrated in 18 out of 23 cases (78.3%). In 2 cases revealing nuclear staining only, the worse histological features were more pronounced than in 3 cases with cytoplasmic staining only. Our results suggest that nuclear positivity of survivin may correlate with the degree of malignancy. In addition, we conclude that overexpression of survivin involved in the pathogenesis of melanoma represents an important diagnostic marker.     

Interwoven dendritic processes of follicular dendritic cell sarcoma demonstrated on ultrafast papanicolaou-stained smears: a case report

BACKGROUND: Follicular dendritic cell (FDC) tumor is a rare tumor derived from accessory cells in the lymphoid follicles. FDC tumors are typically diagnosed on histology based on immunoreactivity to at least 1 of the FDC markers (CD21, CD23 or CD35) or based on the characteristic ultrastructural feature of long, interwoven, cytoplasmic, dendritic processes connected by desmosomes. CASE: We observed novel cytologic features of FDC sarcoma in a liver fine needle aspirate of a 46-year-old man status post surgery and chemotherapy for FDC sarcoma, originating in the gastrointestinal tract with metastases to the liver, pancreas and spleen. In the Diff-Quik- and Papanicolaou-stained smears, the tumor cells presented in syncytial fragments as well as single cells, as previously reported in the cytologic literature. However, the single cells were interconnected to neighboring single cells via long, thin, threadlike cytoplasmic processes in ultrafast Papanicolaou (UFP)-stained smears. The tumor cells possessed multipolar cytoplasmic processes rather than unipolar ones, as previously reported. CONCLUSION: The ultrastructural features of a web of interwoven, dendritic, cytoplasmic processes of FDC tumor was demonstrated for the first time on cytology. Observation of this feature may allow the diagnosis to be made on cytology prior to histology, immunohistochemistry or electron microscopy.     

Choice of expression vector alters the localization of a human cellular protein

The fusion of synthetic epitopes with proteins of interest is an important tool in the identification and characterization of recombinant proteins. Several mammalian expression vectors are commercially available containing unique identification tags or epitopes. These vectors offer a great advantage to researchers, as highly specific antibodies and purification resins against these specific epitopes are readily available. The tags facilitate immunologic assays and the purification of the recombinant proteins. The fusion of these epitopes with the recombinant proteins is not expected to alter the behavior of the protein of interest. In this report, we demonstrate that the mere expression of a cellular protein, hVIP/mov34, which we earlier identified as a cellular HIV-1 Vpr ligand, in two different vectors clearly altered its localization pattern in HeLa cells. Specifically, cloning of hVIP/mov34 in pcDNA3/HisA resulted in its nuclear localization, whereas the expression of this gene from a TOPO cloning expression vector, pcDNA3.1/V5/His, resulted in cytoplasmic expression. The native staining pattern of hVIP/mov34 using polyclonal antisera raised against hVIP/mov34 demonstrated cytoplasmic staining. During cloning, other leader sequences intended for targeting this protein into a cytoplasmic or a nuclear location were not fused to the actual ORF of this protein. Also, the amino acid sequence of the fusion region arising from cloning of hVIP/mov34 in both vectors does not match any reported NLS sequences. These results indicate that the choice of the expression vectors, as well as the position of synthetic epitopes, can significantly alter the behavior and the biology of recombinant proteins. This result suggests the need for a careful examination of these features when characterizing a newly identified protein.     

The cytoplasmic sites of the snRNP protein complexes are punctate structures that are responsive to changes in metabolism and intracellular architecture

Five anti-Sm monoclonal antibodies, Y12, 7.13, KSm4, KSm6, and 128, stain similar discrete punctate structures distributed throughout the cytoplasm of hamster fibroblasts in addition to the expected intense nuclear staining. Several criteria suggest the cytoplasmic staining reflects the cytoplasmic pools of snRNP core proteins. The relative intensity of the cytoplasmic staining is similar to the 30% relative abundance of the cytoplasmic snRNP core proteins compared to the nuclear snRNP core proteins based on cell-fractionation studies. Moreover, the cytoplasmic staining is removed by the same extraction conditions that solubilize the pools of cytoplasmic snRNP core proteins. The cytoplasmic sites of staining are typically spherical but heterogeneous in diameter (0.2-0.5 microm). The larger particles greatly exceed the diameter of individual snRNP core particles and are likely to represent centers of many snRNP proteins or snRNP protein complexes. The staining, though punctate, is evenly dispersed throughout the cytoplasm with no evidence of major compartmentalization. The cytoplasmic staining pattern collapses into larger foci of intensely staining structures when cellular energy levels are depleted or when cells are exposed to hypertonic medium. Unlike the normal sites of snRNP protein cytoplasmic staining, these larger collapsed foci resist detergent extraction. These results suggest that the cytoplasmic staining identified with the anti-Sm monoclonal antibodies represents the large pools of snRNP core proteins in the cytoplasm.     

Ultrastructure of macrocellular (large cell) carcinomas of the lung

The electronmicroscopic investigation of five lung tumors histodiagnosed as macrocellular carcinomas showed the ultrastructural monomorphism of large, variedly shaped neoplastic cells, lack of intercellular junctions, voluminous nuclei with many indentations of nuclear membrane, dispersed euchromatin, large and multiple nucleoli, and nuclear bodies. A reduced number of cytoplasmic organelles was characteristic for these cells, represented mainly by mitochondria, rare rough endoplasmic reticulum, free ribosomes rare Golgi vesicles and flattened tubules, and a various amount of tonofilaments. These features characterized the poorly differentiated proliferation forming these tumors. The elements of differential diagnosis from other poorly differentiated lung tumors (epidermoid and cylindrocubic) are discussed, allowing the consideration of this proliferation type with repressed differentiation and maturation as a real one in the framework of lung carcinomas.     

Pineal gland in rats with 7,12-dimethylbenz(a)anthracene-induced mammary tumors subjected to manipulations known as enhancers of pineal actions

The ultrastructure of pinealocytes was studied in rats with 7,12-dimethylbenz(a)anthracene-induced mammary tumors which were subjected to experimental manipulations known as enhancers of pineal actions (anosmia, underfeeding or cold exposure). In these animals we found: (I)--more nuclei with deep nuclear invaginations; (II)--a large number of cytoplasmic organelles, including lipid droplets, myeloid bodies, synaptic ribbons and lysosomes; (III)--numerous degenerative changes. In general, we found an increase in structural features related to pineal photoneuroendocrine activity. Our results indicate that pineal-dependent inhibition of neoplastic growth induced by these experimental manipulations, previously reported, can be mediated through an increase in pineal metabolic activity.     

Comparative surface morphology of marine coelomic gregarines (Apicomplexa, Urosporidae): Pterospora floridiensis and Pterospora schizosoma

Two species in the aseptate gregarine genus Pterospora from the Pacific and Gulf coasts were analyzed by scanning electron microscopy, which revealed characteristics not reported in other gregarines. The gamonts of these species had branching trunks that ended in terminal digits, and both species moved by cytoplasmic streaming and peristalsis. Pterospora floridiensis had surface pits and tracts of parallel ridges that bended and connected with one another. Pterospora schizosoma had irregular-shaped surface swellings that were usually arranged in rosette patterns. These unique surface features have not been reported for other gregarines, and are strikingly different from the surface features of many septate and aseptate gregarines that inhabit the intestinal lumena of their hosts and move by gliding. The correlation of Pterospora's unique pellicular features to the habitat and cytoplasmic streaming characteristic of the genus may be significant, and may reflect an adaptation for development in coelomic environments.     

Fine needle aspiration cytology of the Ewing's sarcoma family of tumors

OBJECTIVE: To study the cytomorphologic features of the Ewing's sarcoma (ES) family of tumors. STUDY DESIGN: During a period of eight years (1990-1997), 123 soft tissue tumors and 65 bone tumors were evaluated by fine needle aspiration cytology (FNAC); 14 cases were diagnosed as in the ES family of tumors. The ages of the patients ranged from 8 to 30 years. All the cases were histologically confirmed. RESULTS: Of 14 cases of the ES family of tumors, 7 were ES, 3 extraosseous ES (EOE), 2 peripheral primitive neuroectodermal tumor (PPNET) and 2 Askin tumor. Cytologically, smears from all the cases showed round tumor cells with a high nuclear/cytoplasmic ratio. On detailed examination, subtle differentiating features were observed. The cells in ES had finer nuclear chromatin in comparison to those of PPNET and Askin tumor, and punched-out clear cytoplasmic vacuoles were present. PPNET showed nuclear molding, unipolar cytoplasmic tags and Homer-Wright rosettes. Histologically, all cases of ES and EOE and one case of Askin tumor showed periodic acid-Schiff-positive inclusions. CONCLUSION: FNAC features coupled with clinical findings enable a rapid diagnosis of the ES family of tumors, from which treatment modalities can be determined.     

Uterine PEComa: appraisal of a controversial and increasingly reported mesenchymal neoplasm

In recent years, a group of tumors that have been designated "perivascular epithelioid cell tumors" (PEComa) have been reported with increasing frequency from a wide variety of anatomic locations. The uterus and retroperitoneum appear to be the most frequent sites of origin for these lesions. PEComas belong to an identically named family of tumors comprised of conventional angiomyolipomas, clear cell sugar tumors, lymphangiomyomatosis and clear cell myomelanocytic tumor of the falciform ligament/ligament teres, and are also known as PEComa-NOS. This article is a primer for clinicians on the most salient clinicopathologic features of uterine PEComas, as most of the debate and discussion have taken place in the pathologic literature. The author appraises in detail the current state of knowledge on PEComas of the uterus based on a review of published data on the 44 previously reported cases, and comments on areas of controversy. The latter are centered predominantly on the significant morphologic and immunophenotypic overlap that exists between uterine PEComa and some smooth muscle tumors of the uterus. The clinicopathologic features of cases reported as epithelioid smooth muscle tumors and cases reported as uterine PEComas are compared and contrasted, and a practical approach to their reporting is proposed.     

Antibody-specific detection of CAIX in breast and prostate cancers

Carbonic anhydrase IX (CAIX) is frequently expressed in human tumors and serves as a marker for hypoxia. Further, CAIX expression is considered a predictor of poor survival in many, but not all, cancer types. Herein, we compare the specificity of two CAIX antibodies: the M75, monoclonal antibody which recognizes an epitope in the N-terminus and a commercially available polyclonal antibody generated against a C-terminal peptide (NB100-417). Western blot analysis of multiple breast cell lines revealed that the polyclonal antibody detected both membrane-bound and soluble proteins. The M75 antibody recognized only the membrane-bound species, which is presumed to be CAIX. These data were confirmed in an aggressive prostate cell line. We further compared these antibodies in prostate tumors by immunohistochemistry. Staining with NB100 was comparable to that of the M75 antibody, but only at high dilution. Otherwise, cytoplasmic staining was also noted. Two-dimensional gel electrophoresis followed by mass spectrometric analysis revealed that the cytoplasmic protein detected by NB100 is β-tubulin. This cross-reactivity could lead to false-positives for CAIX expression in samples where cytosolic proteins are present.     

Immunohistochemical expression of rabphilin-3A-like (Noc2) in normal and tumor tissues of human endocrine pancreas

Involvement of rabphilin-3A-like (RPH3AL), or Noc2, the potential effector of Ras-associated binding proteins Rab3A and Rab27A in the regulation of exocytotic processes in the endocrine pancreas has been demonstrated in experimental models. Noc2 expression together with other regulatory molecules of the exocytotic machinery in human tissues, however, has not been studied. We evaluated immunohistochemical expression of the key molecules of the exocytotic machinery, Noc2, Rab3A, Rab27A, and RIM2, together with the characteristic islet cell hormones, insulin and glucagon in normal and endocrine tumor tissues of human pancreas. Normal pancreatic islets were stained for all of these proteins and showed strong cytoplasmic localization. A similar pattern of strong cytoplasmic expression of these proteins was observed in the majority of endocrine tumors. By contrast, the exocrine portions of normal appearing pancreas completely lacked Rab27A staining and showed decreased expression of the proteins, Noc2, Rab3A, and RIM2. The staining pattern of Noc2 and Rab27A was similar to the staining pattern of glucagon-producing cells within the islets. The concomitant expression of Noc2 with these molecules suggests that Noc2 may serve as an effector for Rab3A and Rab27A and that it is involved in the regulation of exocytosis of the endocrine pancreas in humans.