Sialadenitis with crystalloid formation. Fine needle aspiration cytodiagnosis of 15 cases

OBJECTIVE: To assess the utility of fine needle aspiration cytology in the diagnosis of sialadenitis with crystalloid formation. STUDY DESIGN: In 15 cases, salivary gland masses were aspirated using a disposable, 20-mL syringe and 25-gauge needles, maintaining negative pressure. Smears routinely were air dried and stained by Diff-Quik (Dade Behring AG, Düdingen, Germany). Occasionally smears were fixed in alcohol and stained by the Papanicolaou method. RESULTS: The smears showed large numbers of non-birefringent crystalloids of varying sizes and shapes. The crystalloids stained deep blue with Diff-Quik and bright orange with Papanicolaou stain. Multinucleated histiocytes, neutrophilic leukocytes and benign salivary gland parenchyma were found, also. CONCLUSION: Fine needle aspiration cytology provides an accurate diagnosis of sialadenitis with crystalloids and is useful for avoiding unnecessary surgery.     

Needle aspiration cytodiagnosis of the breast with abundant acellular calcific material mimicking soft tissue calcinosis

OBJECTIVE: To investigate calcific deposits in breast tissue by needle aspiration cytology (NAC). STUDY DESIGN: The aspirate was obtained using a disposable 10-mL syringe and 22-gauge needle. No smears were made, and material was collected as needle and syringe washings in a cytology container in which 30% ethyl alcohol in physiologic saline was present. From about half of this material, filter preparations were made on 3-microm Schleicher and Schuell filters and stained by the Papanicolaou method; the remainder of the aspirate was spun, and a cell block was made from the sediment and sections cut and stained with hematoxylin-eosin (H-E) stain. RESULTS: The filter preparations and sections of cell block in all the cases showed numerous amorphous, basophilic, deep-stained fragments of refractile material and some fragmented bod ies and concentric lamellations, which were diagnosed as calcium. No breast elements or malignant cells were found. The patients had no further treatment and on follow-up were clinically well, with no changes. CONCLUSION: The 9 cases described are interesting because the cytohistologic findings in the NAC sample mimicked soft tissue calcinosis.     

Inflammatory pseudotumor of the parotid gland: report of a case with fine needle aspiration cytology

BACKGROUND: Inflammatory pseudotumor is a rare lesion of the parotid gland. It usually presents as a mass lesion; thus, the clinical and radiologicfeatures often suggest malignancy. To the best of our knowledge, fine needle aspiration cytologic findings in parotid inflammatory pseudotumor have not been reported previously. CASE: A 59-year-old male presented with a palpable right parotid mass. Computed tomography revealed a mass measuring 2.5 cm in diameter. Fine needle aspiration cytology showed inflammatory cells, foamy histiocytes and groups of spindle-shaped cells without cytologic atypia. A diagnosis of inflammatory pseudotumor was suggested and was confirmed on histology. CONCLUSION: In the presence of a clinically evident mass in the parotid gland and fine needle aspiration cytologic features of inflammatory cells with sheets of spindle cells, the diagnosis of inflammatory pseudotumor should be suspected. The differential diagnosis of this unusual parotid gland lesion principally includes sialadenitis and myoepithelioma.     

Lymphoepithelial cyst with crystalloid formation. Cytologic features of two cases

BACKGROUND: The presence of amylase crystalloids (AC) in cystic lesions of the parotid gland is a rare occurrence and has been diagnosed to date as sialadenitis. We report the first two cases of parotid lymphoepithelial cyst (LC) containing this type of crystalloid. CASES: Case 1, a 56-year-old male, presented with a 3-cm parotid cyst. Fine needle aspiration (FNA) was performed on the mass. Smears showed numerous crystalloids identical to those described as crystallized amylase. Case 2, a 36-year-old female, had a 2-cm parotid mass. FNA smears exhibited the same features as did case 1. The two patients were treated with superficial parotidectomy, and an LC containing AC was diagnosed in both cases. CONCLUSION: When the above findings are present on FNA of parotid gland, the diagnosis of LC must be considered.     

Fine needle aspiration cytology of seromas of the breast from irradiated lumpectomy sites

OBJECTIVE: To study the cytologic features of cells in breast aspirates of seromas in women who had undergone irradiation at lumpectomy sites. STUDY DESIGN: Cytologic material from 38 females with an age range of 39-72 years who had undergone aspiration of seromas were retrieved to determine tumor recurrence or other atypia. The material was obtained using the conventional method of needle aspiration with a 22-gauge needle and 10-mL syringe, maintaining negative pressure. The syringe and needle contents were washed in a cytology container containing 30% ethyl alcohol in physiologic saline. From half the washings filter preparations were made and stained by the Papanicolaou method, while from the other half cell blocks were made and sections cut after processing and stained with hematoxylineosin. RESULTS: In 2 of 38 patients, filter preparations and cell blocks showed malignant cells of breast carcinoma that were similar to the primary. This was confirmed on core biopsy and subsequent mastectomy. In 21 of 38 cases mildly atypical cells with degenerative effects, mild hyperchromasia, liberal cytoplasm, macrophages, inflammatory cells and a few apocrine cells were seen, while in 11 of 38 patients scanty debris, few inflammatory cells, rare apocrine cells and a few macrophages were found. In 4 of 38 cases highly atypical cells with hyperchromatic nuclei and nucleoli were noted. However, a core biopsy in all 4 patients revealed no evidence of residual tumor. CONCLUSION: Cell atypia in aspirates from seromas should be interpreted with caution to avoid unnecessary, invasive surgery, keeping in mind that radiation can cause misleading changes. However, patients with clinical indications of recurrent tumor or with severe atypia should undergo biopsy to permit appropriate management.     

Ag-NOR technique in fine needle aspiration cytology of salivary gland masses.

Because of their complexity, salivary gland lesions are often difficult to identify correctly with fine needle aspiration cytology. To see whether the Ag-NOR staining technique for nucleolar organizer regions would be useful in this respect, we studied a series of smears from benign and malignant salivary gland lesions. The smears, previously treated with Papanicolaou and May-Grünwald-Giemsa stain, were destained and restained with Ag-NOR silver. The correlation between the cytologic-histologic diagnosis and the number of Ag-NORs in benign (sialadenitis, pleomorphic adenoma, oncocytoma and Warthin's tumor) and malignant lesions (adenoid cystic carcinoma, adenocarcinoma, carcinoma ex pleomorphic adenoma and squamous carcinoma) was statistically significant (P = less than .05). The Ag-NOR technique appears useful in the diagnosis of salivary gland lesions. One great advantage is that previously stained slides can be reused for silver staining, thus providing an excellent guide to the diagnosis, especially in doubtful cases and when corresponding histologic specimens or extra unstained slides are unavailable.     

Fine needle aspiration cytology of parotid sarcoidosis

Granulomatous lesions of the salivary gland are rare; as such, there have been few reports of the cytologic features of granulomatous sialadenitis in general, and salivary gland sarcoidosis in particular. A case of systemic sarcoidosis involving both parotid glands, diagnosed initially by fine needle aspiration (FNA) cytology, is presented. The specific cytologic features included histiocytes of both epithelioid and giant multinucleated types, without background necrosis. The FNA cytologic differential diagnosis of bilateral parotitis is discussed.     

Fine needle aspiration biopsy of three cases of squamous cell carcinoma presenting as a thyroid mass: cytological findings and differential diagnosis

M. Rosa and K. Toronczyk Fine needle aspiration biopsy of three cases of squamous cell carcinoma presenting as a thyroid mass: cytological findings and differential diagnosis Objective: Primary squamous cell carcinomas of the thyroid gland are extremely rare, comprising about 1% of thyroid malignancies. Although squamous cell carcinomas are readily identified as such on aspiration cytology in the majority of cases, the differentiation of primary versus metastatic tumour might not always be easy. Herein, we report three cases of squamous cell carcinomas involving the thyroid gland. Methods: Fine needle aspiration cytology (FNAC) was performed in three patients with a thyroid mass using standard guidelines. Smears were stained with Diff‐Quik and Papanicolaou stains. Results: Two patients were male and one was female, aged 59, 45 and 35 years, respectively. In all three patients a thyroid mass was present. FNAC smears in all cases showed cytological features of squamous cell carcinoma including keratinization and necrosis. After clinical and cytological correlation, one case appeared to be primary, one case metastatic, and in the third case no additional clinical information or biopsy follow‐up was available for further characterization. Conclusions: Because primary squamous cell carcinoma of the thyroid is a rare finding, metastatic squamous cell carcinoma should always be excluded first. Metastatic disease usually presents in the setting of widespread malignancy, therefore a dedicated clinical and radiological investigation is necessary in these cases. In both clinical scenarios the patient’s prognosis is poor.     

Fine needle aspiration cytology of adenocarcinoma of the rectovaginal septum. A case report

BACKGROUND: Adenocarcinoma arising in the rectovaginal septum is exceedingly rare and is difficult to diagnose by pathologic examination prior to surgery because of the anatomic position of the tumor. CASE: A 42-year-old woman presumed to have adenocarcinoma of the rectovaginal septum underwent fine needle aspiration for diagnosis. Although a previously performed biopsy from the posterior vaginal fornix was unsuccessful, fine needle aspiration cytology via the posterior vaginal wall detected adenocarcinoma cells. The cell clusters were composed of cells with enlarged and hyperchromatic nuclei. The nuclei themselves demonstrated round and/or irregular morphologic patterns, with high nuclear/cytoplasmic ratios, and often contained an enlarged, round nucleolus and sometimes multiple ones in a single nucleus. Aniso-nucleosis was severe, and the chromatin patterns ranged from coarse to finely granular. The cytoplasm was narrow and lightly stained. Following fine needle aspiration, the patient underwent posterior exenteration on the basis of the cytologic diagnosis. CONCLUSION: Fine needle aspiration cytology was useful in establishing the preoperative diagnosis of adenocarcinoma of the rectovaginal septum, and curative exenterative surgery could be then performed. To our knowledge, this is the first report of fine needle aspiration cytology of adenocarcinoma at this location.     

Value of image-guided needle aspiration cytology in the assessment of pelvic and retroperitoneal masses. A study of 112 cases

OBJECTIVE: To evaluate the diagnostic value of the noninvasive method of image-guided needle aspiration cytology (NAC) in the assessment of radiologically detected pelvic and retroperitoneal space-occupying lesions (excluding the pancreas, kidney and adrenal). STUDY DESIGN: NAC was performed under computed tomographic or ultrasound guidance on 112 patients suspected of having a pelvic or retroperitoneal mass. Cytologic examination was performed on site after staining smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks; further support was obtained with a tissue biopsy in some cases. Additionally, pertinent immunoperoxidase and/or histochemical studies were done. RESULTS: Eighteen cases were diagnosed as inflammatory lesions, 17 cases consisted of normal cellular elements, and 12 cases showed scanty material and were considered unsatisfactory/inadequate for a diagnosis. Five cases were suspicious for malignancy, and in 39 cases metastatic tumors were diagnosed from a previously known primary. Thirteen cases were diagnosed as lymphoma, and in 8 cases a diagnosis of soft tissue sarcoma was made. There were no false positive diagnoses of malignancy. Cell block preparations and immunohistochemistry were helpful with tumor typing, although lymphoma subtyping and soft tissue tumor typing generally required open biopsy. CONCLUSION: NAC, as the first-line investigation, is not only useful in the diagnosis of space-occupying lesions of the pelvic and retroperitoneal region but can also help in choosing appropriate management. The technique is most useful in diagnosing metastases but is also helpful in excluding malignancy in some cases and in suggesting diagnoses of lymphomas and soft tissue tumors.     

Diagnosis of the rare solid and papillary epithelial neoplasm of the pancreas by fine needle aspiration cytology. Light and electron microscopic study of a case

A case of the rare solid and cystic papillary tumor of the pancreas in a young woman is described. The diagnosis was made by fine needle aspiration cytology, with electron microscopic examination of the needle washings. The preoperative cytologic diagnosis enabled appropriate surgical treatment to be planned and carried out without undue delay. It is important to distinguish this rare tumor from other pancreatic tumors with similar cytohistologic features since, if diagnosed correctly and managed surgically, this neoplasm is associated with a good prognosis.     

Fine needle aspiration of subcutaneous masses caused by Aspergillus: a report of 2 cases

BACKGROUND: Fine needle aspiration biopsy is a well-established method for dijfrrentiation of infective from neoplastic lesions. Varions infective agents, such as mycobacteria, leishmaniasis and microfaria can be diagnosed from aspirates, but there are few case reports on fungal infections in aspirates. Cytologic diagnosis of Aspergillus has occasionally occurred on sputum, pulmonary samples, vaginal secretions, endometrial washings and maxillary sinus specimens. One case of hepatic and subcutaneous masses was diagnosed as Aspergillus by fine needle aspiration and confirmed by culture and histology. CASES: Two cases of subcutaneous aspergillosis were diagnosed by fine needle aspiration and confirmed by culture and histology. CONCLUSION: Fine needle aspiration cytology is a rapid, sensitive and important method of diagnosing Aspergillus and provides a rapid diagnosis, which may be life saving in an immunocompromised patient.     

Diagnostic value of needle aspiration cytology in the assessment of palpable axillary lymph nodes. A study of 336 cases

OBJECTIVE: To evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable axillary lymph nodes and determine whether ancillary procedures can be useful in enhancing the diagnosis. STUDY DESIGN: The material was analyzed in 336 cases with enlarged axillary lymph nodes in which NAC were performed by the conventional method. In all cases cytologic examination was done on site after staining the smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks, which showed the reliability of histologic architecture; further support was obtained with tissue biopsy and/or comparison with the primary tumor in some of the cases. RESULTS: Twelve cases were diagnosed as inflammatory lesions, and 64 were unsatisfactory due to scanty/acellular samples (despite 2-3 repeat samplings). However, in 6 of these, malignant tumors were later found on a biopsy done due to persistent and continued enlargement of an axillary lymph node or nodes. One hundred twenty-two cases were regarded as negative (normal cellular elements, n = 52; reactive elements, n = 70), and 4 cases were suspicious for malignancy. In 124 cases a variety of metastatic tumors were diagnosed (breast, n = 63; melanoma, n = 22; others, n = 39), and in 10 cases a diagnosis of lymphoma was made. CONCLUSION: NAC of palpable axillary lymph nodes as a first-line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on management. Also, histologic architecture from cell blocks can be correlated with cytology, and such material can be used for histochemical and immunomarker studies.     

Langerhans cell histiocytosis of the thyroid diagnosed by fine needle aspiration cytology. A case report

BACKGROUND: Langerhans cell histiocytosis rarely involves the thyroid gland even in patients with multifocal disease. Unifocal disease apparently confined to the thyroid is even more rare. CASE: A 30-year-old woman presented with a 6-cm mass in the right and a 3-cm mass in the left lobe of the thyroid. Fine needle aspiration cytology showed isolated, loose aggregates and histiocytelike cells with grooved or contorted nuclei mixed in varying proportions with many mature eosinophils, scattered and small lymphocytes, multinucleated giant cells and foamy histiocytes. CONCLUSION: The cytologic features of Langerhans cell histiocytosis are characteristic. A fine needle aspiration cytology diagnosis is confirmed by histopathologic studies, imunohistochemical staining and ultrastructural studies.     

Fine needle aspiration cytology of primary extraskeletal myxoid chondrosarcoma. A case report

BACKGROUND: Extraskeletal myxoid chondrosarcoma is a rare soft tissue tumor of the extremities. Since it usually lacks obvious chondroid differentiation on light microscopy, it needs to be distinguished from other myxoid soft tissue sarcomas. CASE REPORT: The diagnosis of extraskeletal myxoid chondrosarcoma was made on fine needle aspiration in a patient with a swelling in the right calf. Cellular myxoid fragments having round to oval cells with grooved nuclei arranged in a cordlike pattern suggested chondroid differentiation. The diagnosis was confirmed by histopathology. CONCLUSION: Fine needle aspiration cytology can be diagnostic of extraskeletal myxoid chondrosarcoma even in the absence of obvious chondroid differentiation.     

Fine needle cytology of endometriosis: experience with 10 cases

OBJECTIVE: To evaluate whether commonly used cytologic criteria for the diagnosis of endometriosis are sufficiently specific, to assess the possible role of special methods in the differential diagnosis and to assess the clinical meaning and drawbacks of a cytopathologic diagnosis of endometriosis by fine needle aspiration. STUDY DESIGN: We retrieved 10 cases of endometriosis from our files that had been diagnosed primarily by fine needle cytology (FNC) with subsequent tissue study. In some cases additional cytospin preparations and/or smears had been used for cytochemistry (periodic acid-Schiff stain, mucicarmine) or immunocytochemistry (pan-cytokeratin, cytokeratin 7, vimentin, CD10) using a 3-step streptavidin-biotin-immunoperoxidase reaction. RESULTS: The cell pattern and immunocytochemical profile of the cases suggested a diagnosis of endometriosis. All cases were histologically confirmed. CONCLUSION: With optimal preparations a confident cytologic diagnosis of endometriosis may be made with ease, permitting correct treatment of the disease and, in selected cases, planning of preoperative pharmacologic therapy.     

Amyloid in cytologic specimens. Differential diagnosis and diagnostic pitfalls.

OBJECTIVE: To describe and illustrate the characteristic features of amyloid in cytologic preparations and point out its diagnostic pitfalls. STUDY DESIGN: Five fine needle aspirates and one bronchial washing that contained amyloid were retrospectively reviewed. The aspirates were obtained from each of the five following sites: lung, occipital lymph node, thyroid gland, proximal humerus and subcutaneous soft tissue. Smears of all of the aspirates were stained with Papanicolaou stain, and in two cases they were also stained with Diff-Quik. Cell block sections were stained with hematoxylin and eosin. Congo red, CD45 and CD20 were used on selected cases. RESULTS: Amyloid appears as either flocculent material or irregularly shaped fragments with scalloped and pointed edges. The amorphous fragments are acellular and frequently associated with connective tissue cells. They stain eosinophilic to cyanophilic with Papanicolaou stain and deep blue with Diff-Quik. In two cases an exuberant giant cell reaction almost obscured the amyloid. In the thyroid aspirate, the amyloid was misinterpreted as colloid. In bronchial washings and lung aspirates, amyloid has to be distinguished from mucus, alveolar proteinosis, chondroid material and corpora amylacea. When circumferentially surrounded by lymphocytes or plasma cells, flocculent amyloid deposits may simulate adenoid cystic carcinoma. CONCLUSION: Amyloid can be easily overlooked or mistaken for other entities with similar staining qualities. Congo red staining can help to confirm the diagnosis.     

Fine needle aspiration of tophi for crystal identification in problematic cases of gout. A report of two cases

BACKGROUND: The definitive diagnosis of gout is best established by demonstration of monosodium urate (MSU) crystals in the synovial fluid or biopsy. Fine needle aspiration cytology (FNAC) of tophi can play a crucial role in diagnosis. CASES: A 36-year-old chronic alcoholic male developed subcutaneous nodules on both malleoli without a history of arthropathy and with normal serum uric acid levels. FNAC of the nodules demonstrated stacks and sheaves of needle-shaped crystals of MSU. A 50-year-old diabetic male developed multiple nodules on the feet. He gave a past history of painful athropathy. A roentgenogram of the feet was suspicious for gout; however, joint aspiration failed, and the serum uric acid levels were normal. At this juncture FNAC of the feet tophi clinched the diagnosis of gout. In both cases, polarization of needle washings (wet mount) and the fixed, Papanicolaoustained smears showed negatively birefringent, needle-shaped crystals of MSU, thus confirming the diagnosis of gout. CONCLUSION: FNAC of gouty tophi is an easy alternative to synovial biopsy and joint fluid analysis. It is simpler, easier and less painful. As crystals are preserved in stained smears, they can be employed for polarization and confirmation of gout.     

Evaluation of accuracy of fine needle aspiration cytology for diagnosis of canine mammary tumours: comparative features with human tumours

OBJECTIVE: The authors evaluated the accuracy of the fine needle aspiration cytology technique in the diagnosis of 77 canine mammary gland tumours using the same cytological and histological criteria currently applied to the diagnosis of human breast cancer. METHODS: The study was performed in 73 pure or mixed-breed female dogs submitted to surgical resections of 'mammary tumours'. All cytological smears were stained by routine May-Grunwald-Giemsa and Papanicolaou stains. RESULTS: We obtained a correct cyto-histological correlation in 52/77 cases (67.5%) when all cytopathological examinations were considered, and in 52/56 cases (92.9%) when the inconclusive cases were excluded from the analysis. CONCLUSION: Our results demonstrate that, because of the similarity of the cytological findings in the human and canine mammary gland tumours, it is possible to use the same cytological criteria applied in human pathology for the diagnosis of canine mammary gland tumours.