Diagnosis of myiasis by fine needle aspiration cytology: a case report

BACKGROUND: Myiasis is the infestation of tissues and organs by dipteran larvae and is endemic in tropical areas. Diagnosis usually is made by demonstration of a larva or larvae in infected tissue, generally recognizable to the naked eye. In our case, diagnosis was based on fine needle aspiration cytology (FNAC). CASE: A 59-year-old female patient with a painful neck mass was examined at an otorhinolaryngologic department after symptoms for several weeks. The lesion was found to be an absceding lymphadenitis, based on clinical symptoms, palpation and imaging (ultrasound and computed tomography). The lesion did not improve with repeated courses of antibiotics, so surgery was performed. Pus cultures collected after incision were negative, leaving origin of the inflammation undetermined. Smears from FNA of the residual mass demonstrated a worm-like pathogen alien to most European pathologists' experience. The pathogen was identified as a dipteran larva, leading to accurate etiologic diagnosis of myiasis. More scrupulous examination of the patient's history revealed she had spent her vacation in Australia, where she probably acquired the infection. CONCLUSION: Our case demonstrates the growing importance of the pathology of infectious diseases. One reason for this may be the ever-increasing possibility, frequency and distance of travel.     

Cryptococcal lymphadenitis: report of a case with fine needle aspiration cytology

BACKGROUND: Cryptococcosis is one of the opportunistic infections in AIDS, and therefore an expeditious diagnosis is of the utmost importance since once a cryptococcal infection disseminates, it becomes life threatening. CASE: A 40-year-old woman presented with epistaxis, fever and cervical lymphadenopathy for 20 days. Fine needle aspiration showed reactive lymphoid hyperplasia with plump, histiocytoid cells resembling metastatic deposits. The second aspirate showed ovoid to spherical, thick-walled structures that stained positive for periodic acid-Schiff stain and mucicarmine. CONCLUSION: Lymph node fine needle aspiration cytology provides an economical and rather quickly accomplished cytodiagnostic result.     

Cytodiagnosis of hepatic amyloidosis by fine needle aspiration cytology: a case report

BACKGROUND: Amyloid in fine needle aspirates tends to be overlooked due to its rarity. It may appear at virtually any site and can be identified by special stains. CASE: In a case of amyloidosis of the liver, where fine needle aspiration cytology was instrumental in making the primary diagnosis. Smears revealed normal hepatocytes and chronic inflammatory cells. Amorphous material (amyloid) was extensively present between compressed hepatocytic clusters. It stained pale green in Papanicolaou-stained preparations and reddish purple with Giemsa stain. This material was initially thought to be hyalinized granulomas. However, it was later confirmed to be amyloid by using Congo Red stain. CONCLUSION: Whenever amorphous material is present in smears, a high index of suspicion for amyloid needs to be maintained.     

Myxoinflammatory fibroblastic sarcoma: report of a case with fine needle aspiration cytology

BACKGROUND: Myxoinflammatory fibroblastic sarcoma (MFS) is a distinct neoplasm that usually arises in the acral zones of distalextremities. We report, for the first time, the preoperative fine needle a,spiration cytology (FNAC) findings of an MFS case that was confirmed after surgical excision. CASE: An 81-year-old woman presented with a multinodular tumor in the distal right extremity that had been present for 1 year. FNA C of the lesion was performed and followed by local excision. The fine needle aspiration smears contained 2 of the 3 types of neoplastic cells that have been observed in MFS: spindled and ganglionlike cells. The background was myxoid, with a prominent inflammatory infiltrate. Histopathologic examination of the surgical specimen confirmed the diagnosis of MFS. CONCLUSION: Although the cytologic diagnosis was "pleomorphic sarcoma," MFS was considered and local excision recommended, given the reported low grade nature of this entity. However, the need for extreme caution in the diagnosis of soft tissue lesions on cytologic grounds alone cannot be overemphasized.     

Pigmented pheochromocytoma: report of a case with diagnosis by fine needle aspiration

BACKGROUND: Pheochromocytoma is a common tumor of the adrenal medulla, but its pigmented variant is rare. CASE REPORT: A 38-year-old woman presented with complaints of abdominal pain. Ultrasound revealed a right suprarenal mass. Fine needle aspiration (FNA) smears showed the characteristic cytomorphology of pheochromocytoma, with melanin pigment in the cytoplasm. Melanin was differentiated from lipofuschin and hemosiderin by various histochemical stains. Histopathologic findings and immunohistochemical stains confirmed the diagnosis. To our knowledge, this is the first reported case of pigmented pheochromocytoma diagnosed on FNA. CONCLUSION: FNA has proven to be a rapid and conclusive method of diagnosing pigmented pheochromocytoma, with no complications.     

Primary pulmonary botryomycosis diagnosed by fine needle aspiration cytology: a case report

BACKGROUND: Primary pulmonary botryomycosis is an uncommon suppurative bacterial infection of the lung. Cytologic findings by conventional methods and thin-layer preparations in1 case are presented. CASE: A 45-year-old man had primary pulmonary botryomycosis diagnosed by fine needle aspiration cytology (FNAC). Aspiration smears were characterized by densely packed microorganisms surrounded by polymorphonuclear leukocytes. Microbiologic analysis of cytologic material revealed colonies of Streptococcus constellatus. CONCLUSION: FNAC diagnosis of pulmonary botryomycosis offers the opportunity to distinguish this bacterial infection from lung cancer and avoid unnecessary surgery.     

Carcinosarcoma of the palate: report of a case with a diagnosis of sarcomatoid metastasis by fine needle aspiration cytology

BACKGROUND: Carcinosarcoma (sarcomatoid carcinoma) is a rare tumor with a high predilection for the aerodigestive tract. Cytologic diagnosis of metastatic carcinosarcoma has been reported in very few cases. CASE: An 84-year-old woman presented with a 2-cm-diameter, right cervical lymph node that was referred for fine needle aspiration cytology (FNAC). She had received radiotherapy for a palatal squamous cell carcinoma 2 years earlier. The FNAC smears had a sarcomatoid appearance. Repeat fine needle aspiration was performed, with cytologic and immunocytochemical staining. Careful consideration of the cytologic and immunophenotypic features led to an impression of carcinosarcoma. Histologic sections of the palatal biopsy that had been previously diagnosed as squamous cell carcinoma were reviewed, and a final diagnosis of carcinosarcoma was established. CONCLUSION: Metastasis of rare lesions, such as carcinosarcoma may be confusing and difficult to diagnose on FNAC, especially when the cytologic sample shows a predominantly sarcomatoid component. The difficulty is compounded when the sarcomatoid component happens to have been overlooked on the initial histologic assessment. With representative cytologic sampling, immunocytochemical staining and review of the histologic material, the correct diagnosis was achieved in this case.     

Paratesticular spindle cell rhabdomyosarcoma diagnosed by fine needle aspiration cytology: a case report

BACKGROUND: Spindle cell rhabdomyosarcoma is a rare, newly identified subtype ofembryonal rhabdomyosarcoma with improved behavior and a predilection for the paratesticular area. Fine needle aspiration (FNA) cytology findings of embryonal rhabdomyosarcoma have been described. However, there is no previous report on the cytologic findings of spindle cell rhabdomyosarcoma at testicular or extratesticular sites. CASE: A 13-year-old boy presented with a large, right sided scrotal mass. Fine needle aspiration (FNA) was performed for rapid diagnosis. The smears revealed numerous spindle cells and large fragments of cytoplasmic processes with cross-striations and were diagnosed as spindle cell rhabdomyosarcoma. The histologic sections were also diagnosed as spindle cell rhabdomyosarcoma. CONCLUSION: The cytologic findings of this rare tumor have not been reported before. The cross-striations were easily identified in FNA smears, so the diagnosis of spindle cell rhabdomyosarcoma was made confidently. The histologic sections showed only spindle cells with different patterns of arrangement, resembling leiomyosarcoma. The cross-striations were not identified in the histologic sections. In this case cytologic diagnosis aided the histologic diagnosis.     

Pulmonary paragonimiasis. Report of a case with diagnosis by fine needle aspiration cytology.

We report a case of paragonimiasis in a Nigerian woman evaluated for symptoms of chronic respiratory disease five years after chemotherapy for primary lymphoma of the breast. Fine needle aspiration of one of two fibrocavitary pulmonary lesions yielded thick, brown material in which ova diagnostic of Paragonimus westermani were identified cytologically. This disease is unusual in natives of North America but is seen in travelers and immigrants from Asia, Africa, and South and Central America, where it is endemic. The infection can be fatal, especially if it involves the central nervous system. The clinical differential is broad, but an accurate diagnosis may be made by fine needle aspiration, thus allowing proper treatment.     

Cytologic diagnosis of mastocytosis by fine needle aspiration biopsy: a case report

BACKGROUND: Mastocytosis is an abnormal proliferation of mast cells and their subsequent accumulation in various organs. Diagnosis of mast cell disease relies on proper identification of abnormal mast cells. CASE: A 55-year-old man presented with a history of fever for several months, associated with night sweats, involuntary 20lb weight loss, progressive fatigue, weakness, worsening abdominal distention, shortness of breath, and diffuse lymphadenopathy. Physical examination and computed tomography (CT) showed hepatosplenomegaly, massive ascites, and generalized lymphadenopathy. Bone marrow biopsy with immunohistochemistry (ICH) studies revealed mastocytosis. CT-guided fine needle aspiration biopsy (FNAB) of the retroperitoneal lymphadenopathy was performed. The smears were cellular for a mixed population of mature plasma cells, eosinophils, left-shifted granular and lymphoid cells, and abundant abnormal mast cells. The mast cells had round to oval lobulated nuclei, some of which were binucleated or eccentrically located, with coarse, evenly distributed chromatin. Abundant pale cytoplasm contained numerous metachromatic granules. IHC studies and flow cytometry confirmed the cytologic diagnosis of mastocytosis. CONCLUSION: This case highlights the cytologic features of mastocytosis in FNA specimens. IHC stains and flow cytometry are helpful to confirm the cytologic diagnosis. To the best of our knowledge, this is the second case that describes the cytologic characteristics of mastocytosis.     

Orbital Rosai-Dorfman disease: report of a case with fine needle aspiration cytology and histopathology

BACKGROUND: Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy (SHML), is a rare, nonhereditary, benign histiocytic proliferative disorder, affecting mainly the lymph nodes. Orbital involvement in the absence of lymphadenopathy is relatively uncommon. CASE: A 50-year-old woman presented to our hospital with gradual proptosis of the left eye for 5 years. Physical examination revealed no abnormalities, including lymphadenopathy. Ultrasonography and magnetic resonance imaging showed a soft tissue mass in the intraconal retroorbital region of the left eye. Fine needle aspiration cytology of the mass yielded a good number of mature lymphocytes, a few neutrophils, plasma cells and many histiocytes exhibiting emperipolesis. A provisional diagnosis of SHML was suggested and later confirmed by histology of the excised mass. CONCLUSION: Though the orbit is a rare site of extranodal SHML, the disease should be entertained in the differential diagnosis of orbital swellings. To the best of our knowledge, this is the fourth case of SHML involving the orbit exclusively, with no nodal involvement.     

Pulmonary mucormycosis diagnosed by fine needle aspiration cytology. A case report

BACKGROUND: The usefulness of fine needle aspiration cytology (FNAC) in the diagnosis of lung lesions is well documented. Fungal lesions are among nonneoplastic lesions of the lung in which FNAC has proven a useful technique in both immunocompromised and immunocompetent patients. These include cryptococcosis, aspergillosis, histoplasmosis and coccidiodomycosis. Pulmonary mucormycosis, an aggressive fungal infection, is rarely diagnosed on FNAC. We report a case of isolated pulmonary mucormycosis diagnosed on FNAC. CASE: A 62-year-old renal transplant recipient with diabetes mellitus and hypertension, asymptomatic for four months, presented with tachypnea, generalized malaise and weakness. Radiologic studies showed an enlarging, cavitating lesion in the right lung. Computed tomography-guided fine needle aspiration performed on the lung lesion showed fungal profiles with broad, ribbonlike, aseptate hyphae with right-angled branching consistent with the Zygomycetes class of fungi, which includes Rhizopus and Mucor species. Fungal cultures confirmed the presence of Rhizopus. The patient underwent right pneumonectomy, was placed on liposomal amphotericin B therapy and discharged with good pulmonary status and stable kidney function. CONCLUSION: FNAC is a useful technique in the diagnosis of pulmonary mucormycosis.     

Pilomatrixoma as a diagnostic pitfall in fine needle aspiration cytology: a case report

BACKGROUND: Pilomatrixoma (pilomatrixoma, calcifying epithelioma of Malherbe) is a relatively uncommon, benign neoplasm arising from the skin adnexa. The tumor can cause diagnostic difficulty not only for the clinician but also for the cytologist. CASE: A 62-year-old woman presented with a right submandibular swelling of 4 months' duration. The clinical findings were highly suspicious for malignancy. A fine needle aspiration biopsy was performed. Three preliminary differential diagnoses were offered: mucoepidermoid carcinoma of the submandibular salivary gland, squamous cell carcinomatous deposit in a submandibular lymph node and calcifying odontogenic tumor. Computed tomography demonstrated no bony lesion. No primary site of squamous cell carcinoma could be identified. An excisional biopsy of the swelling was performed, and the histologic diagnosis of pilomatrixoma was made. CONCLUSION: The cytologic presentation of pilomatrixoma of the right submandibular region can masquerade as that of a malignant tumor, in this case mucoepidermoid carcinoma, squamous cell carcinoma or odontogenic tumor. This case delineates the cytomorphologic features of pilomatrixoma that may mimic carcinoma.