Fine needle aspiration biopsy diagnosis of giant-cell tumor of bone. An experience with nine cases

The cytologic findings in nine cases of giant-cell tumor (osteoclastoma) of bone diagnosed by fine needle aspiration (FNA) biopsy are described. The aspirates contained a dual population of cells, consisting of mononucleated tumor cells and multinucleated giant cells (osteoclasts). The tumor cells were usually evident in the FNA smears as cohesive perivascular clusters; some were present as sheets or single cells. The most striking feature, which may best suggest the diagnosis of giant-cell tumor in an FNA smear, was the attachment of the osteoclasts to the cohesive groups of tumor cells. Even when the cells were more dissociated, there was a rather regular distribution of the two types of cells. This series further demonstrates that FNA biopsy permits an accurate cytopathologic diagnosis of giant-cell tumor and that its use can clarify the clinical and radiologic impressions of these bony lesions preoperatively. The differential diagnosis between osteoclastoma and other giant-cell containing bone lesions is discussed in detail.     

Neutrophilic phagocytosis by tumor cells. A feature to consider in the differential diagnosis in fine needle aspiration smears

OBJECTIVE: To analyze neutrophilic phagocytosis by tumor cells in fine needle aspirate (FNA) smears from different types of tumor. STUDY DESIGN: A retrospective review of a total of 7 cases showing prominent neutrophilic phagocytosis by tumor cells in FNA smears during the period July 2003-December 2004. RESULTS: This feature was seen in malignant fibrous histiocytoma and poorly differentiated renal cell carcinoma in addition to giant cell carcinoma of the lung. CONCLUSION: Neutrophilic phagocytosis by tumor cells is seen in FNA smears and on cytomorphology. The differential diagnoses should include both pleomorphic sarcomas and carcinomas.     

Hemangiopericytoma in a male breast. Report of a case with cytologic, histologic and immunochemical studies

A hemangiopericytoma in a male breast was studied by fine needle aspiration (FNA) biopsy. The FNA smears contained tissue clumps showing knob-like formations of atypical cells, spindle-shaped cells and fragments of capillaries lined by normal endothelial cells. Immunocytochemical study showed a positive reaction for vimentin, but a negative reaction for desmin and keratin. Staining for Factor VIII was positive only in the capillaries and endothelial cells. The cytodiagnosis was "mesenchymal tumor." Histopathologic study of the mastectomy specimen made the final diagnosis of hemangiopericytoma. While FNA cytology and immunocytochemistry cannot make a definitive diagnosis of this rare vascular tumor, they can be decisive in planning the surgical treatment, as in the present case.     

Fine needle aspiration cytology of primary epithelioid sarcoma. A report of 2 cases

BACKGROUND: Epithelioid sarcoma is a rare soft part tumor, the cytologic features of which have not been fully elucidated to date. We describe the cytologic features in 2 cases of primary epithelioid sarcoma with samples obtained by fine needle aspiration (FNA). CASES: Case 1 was a 50-year-old male who complained of a small mass in his left palm. Case 2 was a 56-year-old female who presented with a mass on the medial aspect of her right forearm. Preoperative FNA smears in both cases showed loose, aggregated and isolated tumor cells that were round to polygonal, with eccentrically located nuclei, against a background of inflammation and necrosis. The tumor cells showed moderate atypia, irregularity in size and many mitoses. In case 1 a presumptive diagnosis of epithelioid sarcoma was made by FNA cytology, while in case 2, FNA cytology revealed a high grade sarcoma with abundant matrix mimicking osteoids, difficult to differentiate from an extraskeletal osteosarcoma. CONCLUSION: Epithelioid sarcoma may be difficult to differentiate from an extraskeletal osteosarcoma in cases with abundant hyalinized collagen on FNA cytology.     

Cytology of recurrent ameloblastoma with malignant change. A case report

BACKGROUND: Ameloblastoma is a rare tumor of the jaw that arises from the odontogenic epithelium. Ameloblastomas have a propensity for local recurrence and, rarely, for metastasis. The term malignant ameloblastoma is reserved for those metastasizing tumors that retain the typical morphology of ameloblastoma. Fine needle aspiration (FNA) reports on ameloblastomas are scant, and those on malignant ameloblastomas are still more so. CASE: In a case of malignant ameloblastoma diagnosed by FNA cytology, the clinical presentation was that of a malignant neoplasm. FNA smears were highly cellular and showed isolated, scattered cells and small groups of basaloid cells and polygonal squamous epithelial cells. Stellate and spindle-shaped cells were also seen in the background. The cytologic diagnosis was subsequently confirmed on histopathology. CONCLUSION: The characteristic combination of cells in FNA smears facilitated the diagnosis of ameloblastoma. Since the biologic behavior of the tumor was that of a malignant neoplasm, the slides were reviewed. The cytologic smears did not exhibit sufficient features of malignancy to label the lesion malignant.     

Fine needle aspiration cytology of clear cell sarcoma. Report of a case with immunocytochemical, immunohistochemical and ultrastructural studies.

Cytologic findings of clear cell sarcoma obtained by fine needle aspiration (FNA) of a tumor are described. The tumor probably originated in the retroperitoneal tissue, and the diagnosis was confirmed histologically by open biopsy. Percutaneous needle aspirates of the intraabdominal tumor and touch preparations obtained from the open biopsy specimen revealed numerous atypical cells with an extremely hyperchromatic nucleus, prominent nucleoli and clear cytoplasm. The cytoplasm was rich in glycogen. The immunocytochemical technique demonstrated S-100 protein and neuron-specific enolase in the cytoplasm, both of which were exhibited also in the histologic specimen. Clear cell sarcoma is a rare tumor of soft tissue, and to our knowledge, detailed cytologic appearances of this tumor obtained by FNA have not been reported. In addition, the present tumor was unique in location. It is possible to diagnose clear cell sarcoma accurately on an FNA cytologic specimen if the periodic acid-Schiff stain and immunocytochemical technique are utilized in addition to the routine Papanicolaou method.     

Fine needle aspiration cytology of perineurioma. Report of a case with histologic, immunohistochemical and ultrastructural studies

The fine needle aspiration (FNA) findings are presented for a case of perineurioma, a benign soft tissue tumor composed of perineurial cells, which are epithelial-like and ensheath the endoneurial connective tissue space of nerve fibers. A subcutaneous FNA performed on a posterior thigh mass of a 14-month-old boy produced a specimen consisting of numerous spindle-shaped tumor cells with bipolar cytoplasmic extensions and occasional pseudosignet-ring cells in a prominent myxoid background. Cytologically, a diagnosis of benign myxoid tumor was made. Histologic examination of the resected tumor revealed the characteristic features that have been described for perineurioma; the diagnosis was confirmed with immunocytochemical and ultrastructural studies. Perneurioma should be included in the differential diagnosis of benign myxoid neoplasms seen in FNA biopsy specimens.     

Primary squamous cell carcinoma of the thyroid diagnosed by fine needle aspiration cytology. A report of two cases.

BACKGROUND: Primary squamous cell carcinoma of the thyroid is a rare malignant tumor that needs to be distinguished from other neoplasms. CASES: Two males aged 65 and 68 years presented with an enlarged right lobe of the thyroid. Thyroid scintigraphy revealed a cold nodule. Clinically malignancy was suspected. Fine needle aspiration (FNA) revealed numerous clusters and isolated malignant cells, dyskeratotic cells and deposits of eosinophilic granular keratin material. Subtotal thyroidectomy was performed. Histologic findings confirmed the cytologic diagnosis of squamous cell carcinoma. CONCLUSION: Primary squamous cell carcinoma of the thyroid is a rare tumor. FNA findings of this tumor were not reported before. FNA study cannot help to differentiate primary from metastatic squamous cell carcinoma of the thyroid.     

Secretory carcinoma of the breast. Report of a case with diagnosis by fine needle aspiration.

We report a case of secretory carcinoma of the breast in a 63-year-old woman studied by fine needle aspiration (FNA). The cytologic features included solid nests, cohesive sheets and isolated tumor cells with intracytoplasmic vacuolization and signet-ring-like forms. Although secretory carcinoma is an unusual breast tumor, especially in adults, the cellular morphology was distinctive on FNA. This could permit the preoperative diagnosis of secretory carcinoma and the planning of optimal surgical therapy prior to an intervention.     

High-grade mucoepidermoid carcinoma of the breast. Fine needle aspiration cytology and clinicopathologic study of a case

A primary high-grade mucoepidermoid carcinoma of the breast was evaluated preoperatively by fine needle aspiration (FNA) cytology in a 72-year-old woman. The smears showed a mixed pattern consisting of clusters of poorly differentiated squamous cells, keratinized squamous cells and vacuolated mucin-secreting cells. The subsequent mastectomy specimen showed a tumor with the features of a high-grade mucoepidermoid carcinoma. Electron microscopy confirmed the diagnosis, reflecting the epidermoid and glandular differentiation of the tumor. The course was rapidly fatal, and the patient died a few months after presentation. A review of the literature indicated that mucoepidermoid carcinoma of the breast is a very rare neoplasm; the FNA cytologic features described in this report may constitute a basis to preoperatively recognize this tumor.     

Retroperitoneal mesenchymal chondrosarcoma. Report of a case diagnosed by fine needle aspiration cytology

An unusual case of retroperitoneal mesenchymal chondrosarcoma diagnosed by fine needle aspiration (FNA) biopsy is described. CT-guided FNA of a mass arising in retroperitoneal soft tissues yielded an amorphous, myxoid material containing two distinct and separate populations of tumor cells. One was an undifferentiated, monomorphic, small cell component with granular cytoplasm and round central nuclei. The second population was an overtly malignant chondroid component scattered within an abundant myxoid matrix showing foamy cytoplasm, marked nuclear pleomorphism and frequent multi-nucleation. These cytologic findings were distinctive and similar to the histologic findings. The differential diagnosis and the possible pitfalls in the FNA diagnosis of this relatively rare tumor are discussed.     

Anaplastic sacrococcygeal chordoma. Fine needle aspiration cytologic findings and embryologic considerations

A case of sacrococcygeal chordoma with anaplastic features is presented. The diagnosis of the anaplastic component was first established by fine needle aspiration (FNA) biopsy, which demonstrated the sarcomatous elements as well as the physaliferous cells characteristic of chordoma. Subsequent histologic examination confirmed these findings. While the FNA cytologic findings of chordoma have been previously reported, this is the first case of an anaplastic chordoma diagnosed by FNA biopsy. The embryologic origin of this unusual tumor and its differential diagnosis are discussed.     

Intraabdominal desmoplastic small round cell tumor. Report of a case diagnosed by fine needle aspiration cytology.

In this report, fine needle aspiration (FNA) findings in a case of intraabdominal desmoplastic small round cell tumor (IADSRCT) are presented. Computed tomographic scan-guided FNA performed on a right upper abdominal mass on a 20-year-old man produced a cellular specimen consisting of monomorphic small round cells with scant cytoplasm and ovoid nuclei. FNA cytology and immunocytochemistry suggested the diagnosis of IADSRCT. Surgical removal of the tumor and detailed histology and ultrastructural studies confirmed the cytologic findings.     

Needle track seeding of papillary thyroid carcinoma from fine needle aspiration biopsy. A case report

BACKGROUND: Dissemination of tumor cells from needle biopsy has been observed in a wide range of tumor types. Fine needle aspiration (FNA) biopsy has become accepted as the first-line test in the evaluation of thyroid nodules. Local recurrence of thyroid cancer from needle track seeding is an extremely rare complication of thyroid FNA. CASE: A 59-year-old woman developed local recurrence of papillary thyroid carcinoma three years after FNA of the primary cancer. Local metastases developed in the skin and sternocleidomastoid muscle. The location of the recurrent cancer and the linear relationship of the metastases indicated that local recurrence was due to needle track seeding at the time of FNA. CONCLUSION: Needle track seeding has been recognized as a possible, albeit rare, complication of FNA of thyroid cancer. Although proper FNA technique can reduce the potential for needle track seeding, its occurrence is an unavoidable complication of FNA evaluation of thyroid malignancies.     

Fine needle aspiration cytology of a large cell calcifying Sertoli cell tumor of the testis

A case of a large cell calcifying Sertoli cell tumor (LCCSCT) of the testis in a 7-year-old boy is presented. Fine needle aspiration (FNA) cytologic smears showed large polygonal tumor cells with abundant finely granular or vacuolated eosinophilic cytoplasm and eccentric nuclei with one distinct nucleolus. A variable amount of amorphous calcification was a constant feature. The light microscopic and ultrastructural features of the tumor cells supported a Sertoli cell origin of the tumor. This tumor is found frequently associated with complex endocrine disorders and usually has a benign course. This case, which appears to be the first such case diagnosed by FNA cytology, shows the efficacy of FNA cytology in the presurgical evaluation of testicular masses.     

Fine needle aspiration cytology of desmoplastic small round cell tumor. A case report.

BACKGROUND: Intraabdominal desmoplastic small round cell tumor (DSRCT) is a recently recognized type of primitive sarcoma characterized by a predilection for young males, a usually very aggressive course and generally unsuccessful therapy. A primitive histologic appearance with prominent desmoplasia and striking divergent multilineage differentiation are well-described morphologic features of this tumor, along with a consistent fusion of the EWS and WT1 genes at the molecular level. The cytologic literature contains only scattered references to this type of neoplasm. Detailed information on the clinical and fine needle aspiration (FNA) biopsy and the immunocytochemical and ultrastructural findings in a patient with DSRCT is presented. CASE REPORT: A 23-year-old male had a firm abdominal mass with multiple secondary lesions of the liver. An FNA biopsy was performed under ultrasonographic guidance. CONCLUSION: FNA of the liver nodules showed cohesive groups of small cells with hyperchromatic nuclei and inconspicuous nucleoli; immunocytochemically vimentin and desmin showed characteristic perinuclear globular positivity. FNA cytology is an effective means of diagnosing deeply located lesions. The cytologic features of DSRCT need to become familiar to pathologists and must be considered in the differential diagnosis of liver metastasis.     

Cytologic findings in a fetal intracranial teratoma. A case report

BACKGROUND: Fetal neoplasms are very rare. Recently we had the opportunity to examine the fine needle aspiration (FNA) biopsy of a fetal intracranial teratoma. CASE: The tumor was found in a 30-week-gestation fetus; the mother was 32 years old, gravida 4, para 1. She presented with a rapid increase in abdominal girth over a two-week period. An ultrasound scan showed severe fetal hydrocephalus and a massive intracranial tumor thought to be a teratoma because of variations in echogenicity and spotty calcification. An FNA biopsy was performed under ultrasound guidance. It showed mainly neuroepithelial cells, so a differential diagnosis of malignant neuroepithelial tumor was considered. At autopsy, several other tissue types were found in the tumor, consistent with a teratoma. CONCLUSION: Advances in diagnosis of fetal anomalies by ultrasound have been associated with an increase in the use of fetal interventions performed in utero. This includes the availability of fetal surgery in some centers. FNA biopsy of fetal lesions does not appear to be well described. Increased experience with this technique is necessary if its full potential is to be realized.     

Breast carcinoma with tumor giant cells. Report of a case with fine needle aspiration cytology

A 31-year-old woman presented with a cystic mass in the left breast. At fine needle aspiration (FNA), the mass felt gritty, and a firm mass remained after drainage of the cyst. Cytologic examination of the aspirate showed mononucleated malignant cells and an array of bizarre malignant multinucleated giant cells. A diagnosis of carcinoma of breast with malignant giant cells was made. Subsequent histologic study of the lesion showed a central cystic cavity lined by bizarre tumor giant cells. Immunocytochemistry and lectin cytochemistry confirmed the epithelial nature of the malignant giant cells. The entities that may yield giant cells on FNA of breast masses are discussed.