Fine needle aspiration (FNA) in the diagnosis of soft tissue tumours; a review of 22 years experience

FNA plays an important role in preoperative diagnosis of soft tissue tumours. A close clinical/morphologic cooperation is essential. FNA should be performed on the most accessible part of the tumour, avoiding penetration of the deep portions of the tumour. Needles 0.7 mm (22 G) are recommended. For deep lesions, needles with a stylet should be used. After the FNA, tattooing of the aspiration channel is recommended, and the channel is surgically removed together with the tumour, if a sarcoma. Material from the FNA can be used for additional examinations, i.e. electron microscopy, immunohistochemistry, DNA ploidy analysis and chromosomal analysis. Those techniques are of great importance in the differential diagnosis, particularly in the paediatric small/round cell tumours. the majority of sarcomas can be defined as low grade or high grade malignant in FNA. For malignancy grading the following parameters are used: cellularity, pleomorphism, chromatin pattern, nucleolar structure, mitotic figures and necroses. Cytodiagnostic details of the most common soft tissue tumours and their differential diagnoses are presented.     

Fine needle aspiration (FNA)-induced necrosis of tumours of the thyroid

Two cases of necrosis of thyroid oxyphilic tumours following FNA are reported. the first patient received surgery 4 weeks after FNA and histological examination revealed an encapsulated and totally necrotic tumour 2 cm in diameter. In the second patient surgery was performed after 25 days. Histological examination showed a 0.7 cm diameter tumour consisting mainly of fibrous tissue with residual oxyphilic tumour cells only in a small peripheral rim. In both patients no capsular or vascular invasion and no blood vessel thrombosis were present. A review of the literature revealed that oxyphilic tumours are susceptible to post-FNA necrosis, which might be due to the compromised vascular supply after FNA in conjunction with the intrinsic energy deficiency of oncocytic tumour cells.     

Fine needle aspiration (FNA) cytology of pilomatrixoma

FNA smears from five histologically confirmed cases of pilomatrixoma were reviewed to delineate the cytological features helpful in diagnosis. A combination of basaloid cells, ghost cells and foreign body giant cells appeared to be necessary in FNA smear for a confident cytodiagnosis of pilomatrixoma. Presence of naked nuclei, nucleated squamous cells and calcification were additional features in favour of the diagnosis. Another 10 cases with initial cytodiagnosis of pilomatrixoma or benign skin appendage tumour were reviewed. Using the above criteria, diagnosis of pilomatrixoma was easy in five cases. One case was problematical due to presence of atypical squamous cells. Initially the cytological features were most commonly confused with epidermal inclusion cyst, giant cell lesion or a squamous cell carcinoma. The main reasons for erroneous diagnosis were lack of awareness of cytological features, predominance of one component over the others, and non‐representative FNA smears. Atypia in nucleated squamous cells, and misinterpretation of basaloid cells as malignant can lead to diagnostic dilemma. Adequate clinical data are also necessary.     

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 (FNA) cytology of Rosai Dorfman disease

deshpande v and verma k. (1998) Cytopathology 9, 329–335
Fine needle aspiration (FNA) cytology of Rosai Dorfman disease
Rosai Dorfman disease (sinus histiocytosis with massive lymphadenopathy (SHML)) is a benign self-limiting disorder that commonly involves the lymph nodes. We reviewed eight cases of this entity aiming to document the cytomorphological features. Of the eight cases, a preoperative diagnosis was suggested in seven cases. Pertinent features included: numerous large histiocytes with prominent emperipolesis (documented by a halo around the cell), fine vacuoles in the cytoplasm and lymphocytes and plasma cells in the background. In some cases the histiocytes showed atypia. In one biopsy-proven case a diagnosis of Hodgkin's was suggested, emphasizing the pitfalls associated with the FNA diagnosis of this lesion.     

Fine needle aspiration (FNA) appearances of malignant myoepithelioma of the parotid gland

We describe the FNA features of five cases of malignant parotid myoepithelioma, the majority of which were thought clinically to be recurrent pleomorphic adenomas. A major finding was cell shape variation: round-oval, polygonal or spindle-shaped, with basophilic cytoplasm. Many were epithelial and plasmacytoid-like and had nuclear grooves, pseudoinclusions, and multinucleation. the true myoepithelial nature of the neoplastic cells was identified in all cases, but only two showed obvious cytological malignant features, both initially and on re-examination. FNA of malignant myoepithelioma may thus show overt features of malignancy, or may lack atypia and malignancy can only be identified on histology. the correct diagnosis can be predicted in FNA samples in certain cases, both in terms of typing and malignancy, whilst sometimes only the myoepithelial nature of the lesion can be assessed.     

Fine needle aspiration (FNA) cytology in the diagnosis of recurrent soft tissue sarcoma

trovik c. s., bauer h. c. f., brosjö o., skoog l. and söderlund v. (1998) Cytopathology 9, 320–328
Fine needle aspiration (FNA) cytology in the diagnosis of recurrent soft tissue sarcoma
We have used FNA cytology to diagnose suspected local recurrences of soft tissue sarcoma. Since 1991, a total of 95 FNA cytologies were performed on 86 patients. There were 47 local recurrences, of which 44 were diagnosed correctly by FNA cytology; one biopsy was inconclusive, and two lesions were incorrectly assessed as benign. Thirty-nine patients proved to have benign lesions in the scar area examined cytologically on 50 occasions. None of the specimens was regarded as malignant, but in four cases FNA cytology was inconclusive. Overall, there were 5% inconclusive cytological biopsies, 0% falsely malignant and 5% falsely benign. The inconclusive and false-negative cytological diagnoses had no important clinical consequences. FNA biopsy provides a simple means of diagnosing local recurrence of soft tissue sarcoma.     

Fine needle aspiration (FNA) biopsy of orbital masses: a critical review of 51 cases

Fine needle aspiration (FNA) biopsy of orbital masses: a critical review of 51 cases
FNA biopsy of 51 orbital masses is critically reviewed. Aspiration was performed with a 23 G needle inserted by an ophthalmologist; the smears were prepared by a cytologist. Forty-two cases (83%) were correctly diagnosed as benign or malignant either with (68%) or without (15%) correct specification of the histology. There were two false-negative and seven inadequate cases. Immunocytochemical stains were performed in five cases using the following antibodies: L26 (Pan B), UCHL1 (Pan T), and immunoglobulin light chains (three cases) in order to distinguish inflammatory pseudotumours from low-grade non-Hodgkin's lymphomas. In two cases we used CAM 5.2 (a monoclonal cytokeratin cocktail) and vimentin to ascertain the epithelial origin of two metastatic tumours. In five other cases cytospins were not adequately cellular for immunocytochemistry. Insufficient material and one false-negative sample were obtained from very fibrotic lesions or from posteriorly located lesions. The results are discussed and compared with other series reported in the literature. Orbital FNA biopsy may be considered a useful tool in the diagnostic approach to orbital masses in which the relatively high number of inadequate aspirations is offset by a low cost-benefit ratio.     

The role of thyroid fine needle aspiration (FNA) cytology in a district general hospital setting

The pilot study was undertaken to evaluate the role of FNA cytology in the clinical management of patients with thyroid swelling, in a District General Hospital (DGH) setting. One hundred and eleven patients were investigated over a period of 3 years, with a total of 142 fine needle aspirations. Statistical analysis showed a sensitivity of 71%, a specificity of 91% and a false negative rate of 2.7%. These results compare very favourably with other institutions. This study therefore shows that thyroid nodule FNA cytology can be performed in a DGH with a high standard of diagnostic accuracy, the results of which play a key role in patient management.     

Fine needle aspiration (FNA) biopsy of primary cutaneous meningioma: report of two cases

Two cases of primary cutaneous meningioma are described. A male and a female patient, aged 56 and 61 years, respectively, presented each with a solitary subepidermal nodule. The initial diagnosis was established in both patients by application of FNA biopsy. The subsequent histologic examination confirmed the cytologic diagnosis. Extensive investigation of the patients by computed tomography (CT) and nuclear magnetic resonance imaging (MRI) scans failed to reveal any primary meningioma of the neuraxis. Neurologic examination and routine laboratory test results were all normal. The microscopic features, immunocytological study and histology, which all gave a similar pattern to that seen in intracranial meningiomas, are discussed. Distinction from other cutaneous lesions that may be considered in the differential diagnosis is made. A brief review of the literature is also presented.     

Fine needle aspiration in the evaluation of testicular leukemic infiltration

Prior to the era of effective therapy for acute leukemia, a finding of occult testicular involvement at autopsy was not uncommon. With the advent of effective induction of remission, clinically evident testicular infiltration has been seen as a manifestation of relapse. A case is reported demonstrating the use of fine needle aspiration along with frozen section in the evaluation of testicular involvement as a manifestation of leukemic relapse.