Fine needle aspiration cytology of Hodgkin's lymphoma: A cytohistologic correlation study from a cancer center in Kuwait

OBJECTIVE: To assess the diagnostic accuracy offine needle aspiration cytology (FNAC) in the diagnosis of Hodgkin's lymphoma (HL). STUDY DESIGN: We selected all the cases in which a cytologic diagnosis of HL, suggestive of or suspicious for HL, or HL as the prime differential diagnosis was offered on FNAC. These cases were correlated with histopathologic follow-up. Cases of primary HL diagnosed on cytology but without histopathology were excluded from the study. RESULTS: Histopathologic follow-up was available in 46 cases. Of these, 42 were correctly diagnosed as HL, and there was a discorrelation in 4 cases, comprising 3 cases of non-HL (T-cell-rich B-cell lymphoma [TCRBCL]-2, anaplastic large cell lymphoma-1) and 1 case of metastatic carcinoma. Overall accuracy was 91.3%. In 14 cases, the cytologic features were diagnostic ofrecurrence; hence, no histopathologic examination was done. No follow-up was available for the remaining 19 cases, which were excluded from the study. CONCLUSION: FNAC is very useful for rapid and accurate approach to the diagnosis of recurrent and most cases of primary HL. Because of morphologic similarities, it is difficult to differentiate HL from anaplastic large cell lymphoma and TCRBCL on FNAC. It is advisable to request a histopathologic examination in all cases of primary HL.     

Fine needle aspiration cytology of breast fibroadenoma. A cytohistologic correlation study of 405 cases.

OBJECTIVE: To evaluate the cytohistologic correlation of breast fibroadenoma (FA) in order to assess the value of cytology in the conservative management of this lesion. STUDY DESIGN: A retrospective analysis of all aspirates diagnosed as FA or fibroadenomatous lesion (n = 1,549) for which a histologic follow-up study was available (n = 362). Forty-three aspirates, including 14 nonrepresentative smears, from histologically proven FAs with a different cytologic report were also included in the study. RESULTS: Cytohistologic agreement was present in 287 of the 362 cytodiagnoses. Lack of correlation was observed in 75 cases. Most diagnostic errors accumulated in the older patient group. The sensitivity of the cytologic diagnosis of FA was 86.9% (90.8% excluding nonrepresentative cases), with a positive predictive value of 79.3%. In 43 cases a histologic diagnosis of FA was given after previous erroneous (n = 29) or nonrepresentative cytodiagnoses (n = 14). The specificity of the cytologic diagnosis of FA reached 93.8%, with a negative predictive value of 96.3% (97.5% excluding nonrepresentative cases). Regarding malignancy, five tumors were diagnosed as FA and were malignant. No false positive diagnoses of malignancy were given, but nine aspirates were included in the category "suspicious for carcinoma." CONCLUSION: FA of the breast remains a diagnostic challenge for the cytopathologist. A considerable amount of benign breast lesions can mimic FA on cytology, and such diagnostic categories as "fibroadenomatous lesion" or "consistent with FA" are associated with low diagnostic accuracy. While the cytologic requisites for entering a program of conservative management of FA are established, it seems that strict diagnostic criteria should be applied even at the expense of diminishing sensitivity.     

Fine needle aspiration of toxoplasmic lymphadenitis in an intramammary lymph node. A case report

BACKGROUND: Cytologic findings of toxoplasmic lymphadenitis (TL) have been only sporadically reported. Intramammary lymph node is an extremely rare site for TL. CASE: A 47-year-old, healthy, female presented with a breast tumor, which was aspirated. The cytomorphologic features were interpreted as suggestive of TL. Histopathology of the excisional biopsy specimen and subsequent serologic examination confirmed the diagnosis. CONCLUSION: We obtained several characteristic findings in aspiration of TL. Of these, epithelioid cell clusters and monocytoid cells were the most diagnostic.     

Fine needle aspiration cytology of the thyroid: a cytohistologic study with evaluation of discordant cases

OBJECTIVE: To analyze the diagnostic efficacy of fine needle aspiration cytology (FNAC) in the initial evaluation of thyroid nodules, with special emphasis on discrepant cytologic diagnoses. STUDY DESIGN: A total of 192 thyroid fine needle aspirates with subsequent histopathologic follow-up were analyzed. The cytologic diagnoses were divided into 4 categories: positive for malignancy, negative for malignancy, indeterminate for diagnosis and nondiagnostic. The detailed cytologic features were studied along with histopathology sections in all these cases by 2 observers (S.J. and P.D) independently. RESULTS: Cytohistologic correlation was seen in 78.1% of cases and discordance in 21.9%. Indeterminate diagnoses accounted for 15.1% of cases. The majority of these were "follicular neoplasms." The overall sensitivity was 84.44% and specificity 99.11 %. A false positive diagnosis was made in 1 case (0.5%), proven a follicular adenoma on histopathologic examination. A false negative diagnosis was seen in 3.6% of cases. These were cases of papillary microcarcinoma. CONCLUSION: FNAC is a safe, sensitive and specific technique in the initial evaluation of thyroid nodules. A correct cytologic diagnosis can be achieved in a majority of cases, thus obviating the need for a second surgical intervention. A careful and diligent search for various cytologic features and accurate sampling can help in reducing the number of indeterminate, false positive and false negative diagnoses.     

Fine needle aspiration cytology of localized Leishmania lymphadenitis

Leishmania lymphadenitis, an uncommon cause of lymphadenopathy, is usually diagnosed by surgical biopsy performed because of suspicion of lymphoma. The cytopathologic features of this disease do not appear to have been previously described. This paper describes the findings in seven cases of Leishmania lymphadenitis diagnosed by fine needle aspiration (FNA) cytology. The identification of Leishman-Donovan bodies in epithelioid cells in the aspirates led to the cytologic diagnosis of Leishmania lymphadenitis, which was histologically confirmed in all cases. Since this disease is self-limiting and requires no treatment, FNA diagnosis is especially useful in that the patient can be spared more invasive diagnostic techniques.     

Fine needle aspiration cytology of suspected tuberculous lymphadenitis

Fine needle aspiration cytology of suspected tuberculous lymphadenitis The aims of this cross-sectional study were to describe the distributional patterns of tuberculous lymphadenitis and to assess the correlation between fine needle aspiration cytology (FNAC) and the Ziehl Neelsen staining technique in diagnosing tuberculous lymphadenitis. Romanowsky's method (Wright's stain) for cytological diagnosis and Ziehl Neelsen (hot method) for the identification of acid-fast bacilli were utilized. Out of one hundred and twenty-eight consecutive patients attending the cytological diagnostic service of the Department of Pathology within Jimma University, 89 (69.6%) of the patients were younger than 30 years of age. The male to female ratio was 1.3 : 1. The cervical region was the most common site and involved 95 cases (74.2%), followed by the axillary and inguinal lymph node regions (20.3% and 4.3%, respectively). The Wright's-stained cytology smears were grouped into three categories: epithelioid granulomas without necrosis, epithelioid granulomas with caseous necrosis and necrosis without epithelioid granulomas. The Ziehl Neelsen stains were undertaken on separate slides: 20.0% of the cases showing epithelioid granulomas without necrosis, 61.9% of those with epithelioid granulomas with necrosis/abscesses and 69.7% of those with necrosis without granulomas were found to be positive for acid-fast bacilli. The overall positivity for the ZiehlNeelsen stained cases was 59.4%. It can therefore be concluded that FNAC is a reliable diagnostic tool in helping to avert the more invasive surgical procedures undertaken in the diagnosis of tuberculous adenitis. The ZiehlNeelsen stain for identification of acid-fast bacilli should be incorporated as an adjunct to increase the diagnostic accuracy of tuberculous lymphadenitis.     

Fine needle aspiration diagnosis of aspiration pneumonia (phytopneumonitis)

Aspiration pneumonia is defined as pulmonary infiltration caused by inhaled material, either solid or liquid, that is inherently toxic or that initiates a toxic response. We present the case of a solitary lung mass of unknown etiology in which cytology of a fine needle aspiration provided a definitive diagnosis of this disorder.     

Fine needle aspiration of breast carcinoma: a preliminary cytoprognostic study

A cytologic grading method for fine needle aspiration smears was applied to 178 histologically confirmed breast carcinomas. Grade I defined a well-differentiated carcinoma, grade II a carcinoma with pleomorphic tumor cells and grade II an anaplastic carcinoma. The cell-to-cell relationship (topography) and the cytologic criteria contributed to the grading. Special attention was paid to grade III tumors, which have an unfavorable prognosis. The correlation of grading with the clinical course of the disease was evaluated after a 12-month followup. In 4% of the patients classified as having grade I disease, 8.9% as having grade II and 66% as having grade III, local recurrence of disease, metastasis or death was observed within one year. The contribution of cytologic grading to the prognosis of breast cancers is discussed.     

Fine needle aspiration in plastic surgery outpatients: a retrospective study

A survey suggested that fine needle aspiration cytology of masses in plastic surgery outpatient clinics was suboptimal. A cytopathologist gave training in the technique and the effectiveness of this intervention was audited. A total of 236 aspirates were taken from 147 patients in the earlier time period and 215 from 149 in the later period. The overall inadequate aspirate rate remained constant at 43%. The most common reasons for poor aspirates were excess blood, unrepresentative adipose tissue and insufficient cellular material. When the specimen was adequate after training, the sensitivity and specificity of the investigation were 96% and 100%, respectively. We present methods for sample optimization. Alternative strategies may be to limit aspiration to one clinician or to refer the patient to a cytopathologist experienced in the technique.     

Fine needle aspiration minibiopsies

During a five-and-one-half-year period, cell buttons were prepared from 393 (29%) of 1,375 fine needle aspirates. Of these, 237 were diagnostically helpful and confirmatory in conjunction with the smears. In 103 (7% of all cases), the tissue fragments in the cell button allowed a definite diagnosis or classification of the tumor that otherwise would not have been possible. The architecture that is often preserved in these minibiopsies is identical to that seen in larger tissue samples. The specimens lend themselves well to special histochemical and electron microscopic studies. Wider use of this established and simple procedure is encouraged.     

Fine needle aspiration (FNA) cytology of extra-adrenal paragangliomas

Fine needle aspiration (FNA) cytology of extra-adrenal paragangliomas We studied nine histologically proved cases of extra-adrenal paragangliomas. Of these, eight cases were correctly diagnosed preoperatively by FNA cytology. Salient cytological features included clusters and discretely scattered cells, with occasional acinar configuration. The cells showed moderate to abundant slightly basophilic cytoplasm with ill-defined margins and round to oval nuclei with mild to marked nuclear pleomorphism. Fine reddish intracytoplasmic granules were also noted (six cases). Cytological features along with clinical data are quite diagnostic of paragangliomas. A correct preoperative cytological diagnosis helps to prevent undue surgical complications. Cytologie par ponction aspiration à l'aiguille fine des paragangliomes extra-surrénaliens Nous avons étudié 9 cas de paragangliomes extra-surrénaliens histologiquement prouvés. Huit cas sur 9 ont été correctement diagnostiqués, à titre pré-opératoire, par cytologie par ponction aspiration à l'aiguille fine. Les caractéristiques cytologiques principales sont la présence d'amas, une dispersion cellulaire modérée et d'occasionnelles formations acineuses. Les cellules comportent un cytoplasme légèrement basophile, moyennement à très abondant, avec des limites mal définies ainsi qu'un noyau rond ou ovale, dont le pléomorphisme nucléaire est modéré ou plus nettement marqué. Le présence de fines granulations rougeâtres intra-cytoplasmiques a également été notée (6 cas). Ces caractères cytologiques, associés aux données cliniques, permettent pratiquement le diagnostic des paragangliomes. Un diagnostic cytologique pré-opératoire correct favorise la prévention des complications chirurgicales indésirables. FNP extraadrenaler Paragangliome Neun histologisch gesicherte Fälle extraadrenaler Paragangliome werden vorgestellt. Präoperativ waren 8 der Fälle zytologisch durch FNP richtig diagnostiziert worden. Charakteristisch waren Einzelzellen und z.T. azinäre Verbände. Die Zellen zeigten mässig bis reichlich, leicht basophiles, unscharf begrenztes Zytoplasma und rund-ovale Kerne mit leichter bis ausgeprägter Pleomorphie. In 6 Fällen lagen feine, rote Granula im Zytoplasma vor. Das zytologische Bild in Zusammenschau mit den klinischen Daten erlaubt eine sichere Diagnose. Auf diese Weise können die operativen Risiken vermindert werden.     

Fine needle aspiration cytology (FNAC) of adrenal masses

Between 1992 and 1998 at the Pathology Section, Cytopathology Unit of the Department of Oncological and Surgical Sciences of the University of Padova, we performed one hundred and twelve FNACs of adrenal masses under radiological guidance and seven intraoperative scrape smears; histological follow-up was available in 55 cases. Immediate on-site assessment of smears revealed a satisfactory adequacy rate (92%). With a simple diagnostic tree, we have been able to classify all smears except one as benign or malignant correctly, (accuracy 97.6%), differentiation of primary tumours from metastatic depositions remaining the most difficult task. In our experience FNAC is a safe and accurate tool in the diagnostic characterization of adrenal masses.