Significance of collagenous and mucinous spherulosis in breast cytology specimens

S. Hata, N. Kanomata, Y. Kozuka, M. Fukuya, E. Ohno and T. Moriya
Significance of collagenous and mucinous spherulosis in breast cytology specimens Objective: Spherulosis of the breast is a rare but distinct benign morphological entity. As there are few cytological reports of breast spherulosis, the significance of spherulosis among cytological specimens is unclear. The objective was to document cytological aspects of spherulosis. Methods: A total of 3491 consecutive breast fine needle aspiration cytology (FNAC) samples and 69 nipple discharge cytology samples were reviewed. Papanicolaou‐stained slides with or without Romanowsky staining were analysed. The corresponding 1926 histological specimens were also reviewed. Results: We detected 17 cases of collagenous spherulosis (CS) and/or mucinous spherulosis (MS) among 3560 breast cytology specimens (0.48%). All samples were from women, who varied in age from 22 to 69 years. CS and/or MS were present in 15 of 3491 FNAC specimens (0.43%) and in two of 69 nipple discharge cytology specimens (2.9%). Corresponding histological specimens were available for 14 of the 17 specimens. Of the 14 specimens, 12 consisted of intraductal papilloma, one of fibroadenoma, and one of fibrocystic change. There was no spherulosis among the 1251 cytological specimens of malignant diseases. Conclusions: Cytological evidence of spherulosis is a good indicator of intraductal papilloma.     

Some cytologic features of hepatocellular carcinoma as seen in fine needle aspirates

Cytologic study of fine needle aspirates in 15 cases of hepatocellular carcinoma revealed the following cellular patterns in order of decreasing frequency: trabecular, acinar and anaplastic. The most useful cytologic criteria for the identification of hepatocellular carcinoma were the similarity of tumor cells to liver cells, the prominence of nucleoli and the frequent presence of a trabecular pattern. Our study showed that the cellular changes seen in aspirated material faithfully reflect the histologic alterations seen in tissue sections. Hence, familiarity with the histology of hepatocellular carcinoma is of tremendous value in the interpretation of cytologic material.     

Benign dermal eccrine cylindroma. A pitfall in the cytologic diagnosis of adenoid cystic carcinoma

Aspiration cytology from four benign dermal eccrine cylindromas and five adenoid cystic carcinomas were compared. These two lesions were found to have so much in common morphologically that they may be indistinguishable on a purely cytologic basis. Accordingly, we recommend a restricted excision to obtain a histopathologic diagnosis before more extensive surgery is performed whenever a lesion is cytologically consistent with adenoid cystic carcinoma but clinically shows a picture that does not exclude dermal eccrine cylindroma.     

Exfoliative cytologic findings of primary pulmonary adenoid cystic carcinom: a report of 2 cases with a review of the cytologic features

BACKGROUND: Adenoid cystic carcinoma is a very rare primary pulmonary neoplasm. Cytologic findings of pulmonary washing and brushing in 2 cases of primary bronchial adenoid cystic carcinoma with special histologic features are described, with an emphasis on some points that have not been reported previously, together with the diagnostic pitfalls. CASES: Two cases of primary adenoid cystic carcinoma of the lung were diagnosed on exfoliative cytology. The patients' ages were 55 and 65 years old. Cytologic findings included large and small clusters of small cells in both 2 and 3 dimensions with occasional cystlike spaces containing mucoid material. The cells were arranged in spherical, cylindrical, basaloid and rosettelike arrangements. There were also abundant small and large mucoid globules, cylinders of homogeneous, acellular, mucous material and "cannon balls." Cytoplasmic and intranuclear round inclusions were noted in case 1. Rare findings of nuclear molding were noted. In case 2, chondromyxoid material and a bimorphic population of tumor cells caused diagnostic confusion with other salivary gland-type tumors of the lung. CONCLUSION: These cases showed characteristic cytologic findings of adenoid cystic carcinoma together with rare findings of intracellular and extracellular inclusionlike bodies, myxochondroid material, bimorphic populations and nuclear molding, which can cause diagnostic confusion with other lung tumors.     

Cytopathologic features of adenoid cystic carcinoma. Case report and literature review

A case of primary bronchial adenoid cystic carcinoma in a 40-year-old white female is reported. Cytologic findings in a bronchial wash specimen obtained at the time of bronchoscopic examination are described, with an emphasis on correlation with the histologic features of the tumor. The literature is briefly reviewed with respect to the occurrence of primary adenoid cystic carcinoma in the bronchial tree.     

Frequency of cytologic features in fine needle aspirates from histologically and cytologically diagnosed fibroadenomas

Identification of key cytologic criteria for various lesions by means of stepwise logistic regression is common today and is often claimed to facilitate cytologic diagnosis. As can be expected, there usually is good agreement between the selected criteria and those given in the cytologic literature. In a study by Bottles et al based on 64 fibroadenomas, stroma, antler horn clusters and honeycomb sheets differentiated fibroadenoma from ductal carcinoma. We applied Bottles's criteria to our fibroadenoma material in order to test their value in clinical cytologic practice. In fine needle aspirates from histologically (cytologically) diagnosed fibroadenomas, stroma was found in 41 (57%), antler horn clusters in 59 (90%) and honeycomb sheets in 62 (81%), which reduced the clinical value of the criteria.     

Cytologic, ultrastructural and immunologic features of intracytoplasmic hyaline bodies in fine needle aspirates of hepatocellular carcinoma

Intracytoplasmic hyaline bodies in malignant cells from an aspirate of a liver mass are suggestive of hepatocellular carcinoma. Such inclusions were studied by light and electron microscopy and by immunocytochemistry in fine needle aspirates from five cases of hepatocellular carcinoma. Seen by light microscopy, the inclusions were round or ovoid and were surrounded by a prominent halo. By both light and electron microscopic immunocytochemistry, the hyaline bodies showed negative staining for alpha-fetoprotein, alpha-1-antitrypsin and cytokeratin. Ultrastructurally, they were not membrane bound and were composed of filamentous, finely granular material, resembling the early stages of Mallory bodies.     

Fine needle aspiration of adenoid cystic carcinoma metastatic to the lung. Cytologic features and differential diagnosis

Two examples of adenoid cystic carcinoma metastatic to the lung, one from a Bartholin's gland and the other from a submandibular gland, were sampled by fine needle aspiration. Although the cytologic features of adenoid cystic carcinoma have been well described, it is easy to confuse adenoid cystic carcinoma with other more common primary small-cell neoplasms of the lung; to determine distinguishing features, we compared the cytomorphology of adenoid cystic carcinoma with well-differentiated adenocarcinoma, small-cell undifferentiated carcinoma and carcinoid tumor of the lung. The differential features distinguishing adenoid cystic carcinoma from these other neoplasms include: (1) tight, globular, honey-comb arrangements of cells lacking true nuclear molding; (2) acellular chunks of basal lamina material, which alone may suggest adenoid carcinoma; and (3) the extension of a solid core of basal lamina material beyond a sievelike cellular meshwork. The morphologic expression of metastatic adenoid cystic carcinoma is so distinctive as to permit a definite diagnosis.     

Clinical and cytologic features of papillary neoplasms of the breast

OBJECTIVE: To compare the cytologic features benign and malignant papillary breast lesions. STUDY DESIGN: We reviewed the clinical and cytologic features in 29 cases of intraductal papilloma and 26 cases of atypical papilloma or papillary carcinoma that had been diagnosed by histologic examination. The diameter of the mass was examined as a clinical feature. The cytologic features evaluated were as follows: bloody background, row of tall columnar cells, naked bipolar nuclei, hemosiderin-laden macrophages, myoepithelial cells, single scattered atypical cells, cellularity, nuclear atypia, nuclear grade, apocrine metaplasia, eosinophilic cytoplasmic granules, papillary clusters, small papillae, cell balls and large sheets. RESULTS: Of the features evaluated, the diameter of the mass, naked bipolar nuclei and cell balls differed significantly between benign and atypical or malignant papillary neoplasms. The average diameter of a benign papillary neoplasm was 1.8 cm, and that of an atypical or malignant papillary neoplasm was 2.2 cm (p = 0.042). Naked bipolar nuclei were found in 27 cases of benign papillary neoplasm (93.1%) versus 19 cases of atypical or malignant papillary neoplasm (73.1%) (p = 0.050). Cell balls were found in 14 (48.3%) and 21 (80.8%) cases, respectively (p = 0.012). All 6 cases in which cell balls were present and naked bipolar nuclei were absent proved to be atypical or malignant papillary neoplasms. Of 17 cases in which cell balls were absent and naked bipolar nuclei present, 13 (76.5%) were benign papillary neoplasms. CONCLUSION: Most cytologic features overlapped in benign and atypical or malignant papillary neoplasms. Although they were not pathognomonic, naked bipolar nuclei and cell balls were cytologic features that differed significantly between benign and atypical or malignant papillary neoplasms. When papillary neoplasms of the breast are suspected in a cytologic smear, the combination of clinical examination, mammography and cytologic features should be considered to make the correct diagnosis.     

Fine needle aspiration biopsy diagnosis of adenoid cystic carcinoma of the breast. A case report.

A case of adenoid cystic carcinoma arising in the breast is presented. The diagnosis was established on a fine needle aspiration (FNA) biopsy sample with histopathologic corroboration. The aspirate yielded a typical smear composed of round, multilayered clusters of uniform epithelial cells arranged around cores of homogeneous, acellular material. Both the conclusiveness of FNA biopsy in diagnosing this rare mammary neoplasm and its resulting in immediate treatment are stressed.     

Histochemical studies on pseudocysts in adenoid cystic carcinoma of the human salivary gland

Summary Pseudocysts are unique structures found in adenoid cystic carcinomata of human salivary glands. They were studied in 13 such cases by histochemical and immunohistochemical means. The pseudocysts contained an abundance of mucoid materials which reacted strongly with both Alcian Blue and dialysed iron ferrocyanide. The mucoid material was digested with chondroitinase ABC and heparitinase, but was resistant toStreptomyces hyaluronidase. The inner surfaces of the pseudocysts were strongly reactive for laminin, whereas the interface between the tumour cell nests and the outer stromal area was intensely reactive for fibronectin. Numerous fibronectin-reactive fibrils and blood coagulation factor XIII (F-XIII)-positive cells were distributed extensively in the outer stromal area. The F-XIII-positive cells were also found within some pseudocysts. The results obtained in the present study have shown that the pseudocysts represent a peculiar structure consisting of basement membrane components; laminin, fibronectin, heparan sulphate and chondroitin sulphate.     

Grave's disease. Appearance in cytologic smears from fine needle aspirates of the thyroid gland

The cytomorphologic features were analyzed in thyroid samples obtained by fine needle aspiration (FNA) from 54 cases proven to be Grave's disease (toxic goiter) by a multiparameter study. A fire-flare appearance of the follicular cells and a good cellularity of the smears were the features most frequently observed in these cases. Hürthle cell changes were present in 47% of the cases, and small numbers of lymphocytes were seen in smears from 41% of the cases. Epithelioid cell granulomata and multinucleated giant cells were observed in less than one-fourth of the cases. About half of the cases showed some degree of pleomorphism of the follicular cells. Twenty cases of toxic multinodular goiter were similarly analyzed; the features that distinguished this entity from Grave's disease were the absence of epithelioid cells and multinucleated giant cells in the FNA smears.     

Fine needle aspiration (FNA) cytology of adenoid cystic carcinoma and adenomyoepithelioma of breast: two lesions rich in myoepithelial cells

Adenoid cystic carcinoma and adenomyoepithelioma are relatively rare, but well described, breast lesions. The FNA cytology features in two cases of mammary adenoid cystic carcinoma and two cases of adenomyoepithelioma are described. In both cases of adenoid cystic carcinoma, aspirates consisted of tightly cohesive clusters of cells arranged around spheres and interconnecting cylinders of acellular material. The two aspirates of adenomyoepithelioma were composed of large tightly cohesive clusters of cells associated with small amounts of stromal material. In all four aspirates a dual population of epithelial and myoepithelial cells could be identified within cellular aggregates, and numerous bare nuclei were present. Histology revealed the characteristic features of adenoid cystic carcinoma and adenomyoepithelioma. Immunohistochemical staining of histological sections for S‐100 protein and alpha‐smooth muscle actin confirmed the presence of large numbers of myoepithelial cells within all four lesions, providing indirect evidence that bare nuclei in breast aspirates represent myoepithelial cells. The presence of a dual population of epithelial and myoepithelial cells and of numerous bare nuclei within a breast aspirate is generally indicative of a benign lesion. This is not always the case, as adenoid cystic carcinoma is a malignant tumour, and adenomyoepithelioma, while generally exhibiting benign behaviour, is capable of local recurrence and distant metastasis.     

Primary cutaneous adenoid cystic carcinoma: a case report and review of the literature.

A case of adenoid cystic carcinoma of the ear in a 67-year-old man is presented along with a review of the literature. Adenoid cystic carcinoma most commonly arises in the salivary glands. Primary cutaneous adenoid cystic carcinoma occurs principally in the scalp and chest. Perineural invasion is seen in at least half the cases and is associated with an increased recurrence rate. Treatment consists of wide local resection with tumor-free margins. Just over half the patients will develop recurrence, with long tumor-free intervals necessitating long-term follow-up. Distant metastases are rarely seen. Radiation therapy is not curative and should be reserved for palliation.     

Karyometric marker features in fine needle aspirates of invasive follicular carcinoma of the thyroid.

Karyometric measurements were performed on fine needle aspirates of clearly identifiable tumor areas and adjacent normal-appearing areas in the surgical specimens from ten patients with invasive follicular carcinoma of the thyroid. Similar measurements were performed on aspirates from nine patients free of thyroid disease (controls). A total of 95 karyometric features were evaluated for each nucleus. Analysis of variance of optical density values indicated (1) a similarity between tumor and normal-appearing nuclei from carcinoma cases, (2) a significant difference between those nuclei and control nuclei and (3) that most of the differences were due to the differences of tissue origin. Stepwise linear discriminant analysis selected ten features that produced a statistically highly significant separation of tumor nuclei from control nuclei. A similar analysis selected six features that produced a statistically highly significant discrimination of normal-appearing nuclei from control nuclei; the validity of those karyometric features as markers of malignancy in normal-appearing nuclei from tissues adjacent to invasive follicular carcinomas of the thyroid was demonstrated by analysis in further training and control sets of nuclei. This analysis in thyroid aspirates identified more marker features than did a previous similar analysis using tissue sections.