Sclerosing polycystic adenosis of the left parotid gland: report of a case with fine needle aspiration cytology

BACKGROUND: Sclerosing polycystic adenosis (SPCA) of major salivary glands is a rare recently described entity. We report a case of SPCA of the left parotid gland, including the cytologic and histopathologic findings. CASE: A 20-year-old man presented with a left parotid mass that had been growing slowly for 3 years. Fine needle aspiration cytology showed many syncytial cell clusters of variable size and some ductal structures with an inflammatory background. The cells forming syncytial clusters were large and polygonal, with abundant, eosinophilic, granular or lacelike cytoplasm. Apocrine differentiation with decapitation secretion was commonly seen. The ductal cells had a relatively high nuclear/cytoplasmic ratio, with granular cytoplasm. Grossly, the 5-cm lesion was a discrete, pale, cystic nodule embedded within the parotid gland parenchyma. Microscopically, the lesion was a nonencapsulated, circumscribed mass of sclerotic and hyalinized, collagenous tissue with lymphoplasmacytic infiltration. Sclerosing adenosis and cystic ducts with frequent apocrinelike cells were commonly seen. Some acinar cells contained eosinophilic, intracytoplasmic granules of various sizes. CONCLUSION: The presence of syncytial clusters with apocrine metaplasia and ductal structures in a lymphoplasmacytic background should suggest a diagnosis of SPCA of a major salivary gland.     

Myoepithelioma of the parotid gland initially diagnosed by fine needle aspiration cytology and immunocytochemistry: a case report

BACKGROUND: Myoepithelioma is a rare, benign tumor of the salivary gland, most commonly affecting the parotid gland. Although the cytologic features of myoepithelioma are documented in a few case reports, it has rarely been diagnosed preoperatively by fine needle aspiration (FNA) cytology. CASE: A 33-year-old man presented with a left parotid swelling 2.5 cm in diameter and of about 5 years' duration. FNA smears showed bundles of spindle-shaped cells as well as plasmacytoid and stellate cells in sheets and dissociated forms. A few cells had nuclear grooves, and occasional cells showed intranuclear cytoplasmic inclusions. In May-Grünwald-Giemsa-stained smears, most of the cells had reddish cytoplasm. Red to purple, myxoid matrix was present as a scanty fibrillar substance and as globules surrounded by tumor cells vaguely reminiscent of adenoid cystic carcinoma. A cytodiagnosis of myoepithelioma was given and corroborated by immunocytochemical staining, which revealed a positive reaction for vimentin, smooth muscle actin and S-100 protein. Epithelial membrane antigen yielded a negative reaction except for a few plasmacytoid cells with weakly positive staining. Histopathology of the resected tumor and immunohistochemical staining confirmed the cytodiagnosis of myoepithelioma. CONCLUSION: FNA cytologic features together with immunocytochemical studies on smears can offer a preoperative diagnosis of myoepithelioma.     

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.     

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.     

Fine needle aspiration cytology of dedifferentiated acinic cell carcinoma of the parotid gland: a case report

BACKGROUND: Dedifferentiation of acinic cell carcinoma (ACC) to undifferentiated carcinoma occurs rarely and entails a poor prognosis. Most cases of dedifferentiation occur as recurrences of a previously excised ACC. More rarely the neoplasm presents with areas of well-differentiated ACC coexisting with dedifferentiated ones. CASE: An 85-year-old man presented with 2 nodular areas in the right parotid area. Fine needle aspiration of both nodules was performed. In both cases cytology revealed a double epithelial component in similar proportions. The first one corresponded to cohesive groups of small to intermediate-sized, polygonal cells with round, monomorphic nuclei. They were distributed in small and larger, branching groups with acinic morphology. Intermixed with this population, irregular groups of larger, pleomorphic cells with irregular nuclei, prominent nucleoli and scarce cytoplasm were present. In addition, smears showed an abundant lymphoid background. A cytologic diagnosis of "salivary carcinoma with coexisting areas of acinic cell differentiation and high grade, undifferentiated carcinoma" was given. Histopathology revealed a well-differentiated ACC with areas of high grade undifferentiated carcinoma (dedifferentiated ACC). CONCLUSION: The current case expands the cytomorphologic spectrum of ACC. Cytology may permit the preoperative recognition of dedifferentiation, allowing a more sound therapeutic approach.     

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.     

Mucinous cystadenocarcinoma of the parotid gland: report of a case with fine needle aspiration findings and histologic correlation

BACKGROUND: Mucinous cystadenocarcinoma of the salivary gland is a rare entity. Review of the literature from 1991 to 1999 revealed no previous reports on its cytologic features. CASE: A 25-year-old man had a slowly growing, painless mass in the left parotid gland. Fine needle aspiration biopsy, performed prior to surgical excision, showed clusters of minimally atypical epithelial cells in which occasional vacuolated cells containing mucin could be seen. Pathologic evaluation of the resected parotid mass showed it to be a mucinous cystadenocarcinoma. CONCLUSION: The cytologic differential diagnosis of mucinous cystadenocarcinoma is with low grade mucoepidermoid carcinoma and with mucinous adenocarcinoma. Mucinous cystadenocarcinoma must be cystic; cysts may be present in low grade mucoepidermoid carcinoma, but their size and prominence varies. Mucinous adenocarcinoma is not cystic but gelatinous. Nuclei are bland in both mucinous cystadenocarcinoma and low grade mucoepidermoid carcinoma but are atypical in mucinous adenocarcinoma. There is no squamous differentiation in either mucinous cystadenocarcinoma or mucinous adenocarcinoma, but it is subtle in low grade mucoepidermoid carcinomas. Mucinous cystadenocarcinoma should be considered a potential candidate in the differential diagnosis of mucinous lesions that can occur in the salivary gland.     

Basal cell adenocarcinoma of the salivary gland: report of a case with morphology on fine needle aspiration cytology

BACKGROUND: Basal cell adenocarcinoma of the parotid is rare and prone to recur. CASE: A 54-year-old woman had a history of afacial mass 12 years earlier that had been excised and was diagnosed as low grade adenocarcinoma of the parotid. Over the years, the patient had multiple local and lymph node recurrences. Histology of the excised local recurrent tumor showed basal cell adenocarcinoma, and FNAC of a separate recurrent nodule was performed. The aspirate showed moderate cellularity of basaloid cells with mildly pleomorphic nuclei, small nucleoli and occasional mitotic figures. The cells were mostly single, but some formed clusters with a rosettelike pattern of tumor cells surrounding central eosinophilic globules. A second, less prominent population of smaller cells with dark-staining nuclei was also noted. The differential diagnosis included adenoid cystic carcinoma, polymorphous low grade adenocarcinoma, and basal cell and pleomorphic adenoma. CONCLUSION: The cytologic features of basal cell adenocarcinoma are not distinctive, but the presence of two cell populations with moderate pleomorphism and a rosettelike pattern with central, eosinophilic globules may assist with its differentiation from other salivary gland neoplasms.     

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.     

Preoperative fine needle aspiration cytologic diagnosis of spindle cell myoepithelioma of the parotid gland: a case report

BACKGROUND: There are only rare case reports of preoperative fine needle aspiration cytologic (FNAC) diagnosis of myoepithelioma of the salivary gland. Myoepitheliomas with pure spindle cell morphology may simulate a variety of benign or malignant spindle cell soft tissue tumors. CASE: A 54-year-old woman presented with a history of progressively increasing swelling in the right parotid region. The clinical diagnosis was parotid malignancy. Routine FNAC yielded highly particulate material. The smears were cellular, with tissue fragments, clusters of spindle cells and numerous small globules and strands of bright magenta material. High cellular yield and pure spindle cell population with an accentuated chromatin pattern in Papanicolaou-stained smears simulated a low-grade spindle cell soft tissue sarcoma. A vague resemblance to a schwannoma was also noted. However, based on the characteristic findings of the May-Grünwald-Giemsa (MGG)-stained smears, a preoperative diagnosis of myoepithelioma was made and confirmed by subsequent histopathologic examination and immunohistochemistry. CONCLUSION: Cytologically, spindle cell myoepithelioma of the salivary gland may simulate low-grade spindle cell soft tissue sarcoma or schwannoma. However, optimal sampling of the lesion and logical interpretation of the MGG-stained smears, in the appropriate clinical situation, allow a confident preoperative diagnosis of these tumors.     

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.     

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.     

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.     

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.     

Meningioma presenting as a parapharyngeal tumor: report of a case with fine needle aspiration cytology

BACKGROUND: Meningiomas rarely extend out of their intracranial confines through skull foramina to present as cervical tumors, where they would be accessible to fine needle aspiration (FNA) and thereby create difficulties in cytodiagnosis by mimicking other, more commonly aspirated head and neck tumors. CASE: A psammomatous meningioma arising intracranially and extending through the jugular foramen presented as a mass at the angle of the jaw clinically. On FNA cytology the diagnosis was suggested, but the cytomorphologic features overlapped with those of more commonly aspirated head and neck tumors, such as acinic cell carcinoma arising primarily in a salivary gland, metastatic papillary thyroid carcinoma and paraganglioma (glomus jugulare tumor). These possibilities had to be excluded through correlation with radiologic and intraoperative findings, which showed a dural-based tumor extending through the jugular foramen to assume a parapharyngeal location. Histology of the final excision specimen confirmed a psammomatous meningioma. CONCLUSION: The possibility of meningioma should be considered in the cytologic differential diagnosis of parapharyngeal tumors, particularly since its cytomorphologic features may mimic those of some of the more commonly encountered and aspirated head and neck tumors.     

Neuroblastoma with concomitant giardiasis: report of a case with diagnosis by fine needle aspiration cytology

BACKGROUND: Diagnosis of two pathologies, including a neoplasm and infectious condition, by fine needle aspiration (FNA) cytology in the same patient is rare. CASE: A 2-year-old, male child presented with fever, abdominal pain and abdominal mass. Imaging findings were strongly in favor of a neuroblastoma. FNA smears from the mass revealed fecal material containing numerous trophozoites of Giardia lamblia. FNA was repeated in view of the imaging findings. Repeat smears showed a small round cell tumor with rosettes and background filamentous/fibrillar material consistent with a neuroblastoma. Chemotherapy reduced the mass considerably. Histopathology of the resected residual mass revealed a ganglioneuroma in addition to remnants of neuroblastoma. The patient was free of disease two years after the initiation of chemotherapy. CONCLUSION: When FNA cytology shows an infectious pathology in the clinical and imaging setting of a tumor, FNA should be repeated so that an important component of the diagnosis is not missed.