Intraoperative cytodiagnosis of metastatic brain tumors confused clinically with brain abscess. A report of three cases

BACKGROUND: Cystic lesions of the brain may have diverse etiologies, ranging from true cysts to malignant tumors with cystic degeneration. Preoperative determination of the exact nature of them as well as intraoperative diagnosis may be sometimes difficult or even impossible. Sensitivity and specificity of diagnosis will be improved by introducing new methods or combining traditional procedures. CASES: Three metastatic brain carcinomas with primary sites of breast, pancreas and prostate presented as cystic lesions and were confused clinically with abscess. Intraoperative frozen section was not revealing. Cytologic study of sediments of aspirated fluid uncovered malignant cells. CONCLUSION: When combined with frozen section, intraoperative cytologic studies in the form of crush preparation, fine needle aspiration or evaluation of aspirated fluid in cystic lesions (as in our cases) can improve diagnostic accuracy by detecting important diagnostic features that otherwise may be missed.     

Fine needle aspiration of the pancreas. A five-year experience

Forty fine needle aspiration (FNA) biopsies of the pancreas were performed on 37 patients with a radiologic suspicion of malignancy; 32 aspirations were guided by ultrasound, 2 were guided by CT, and 6 were obtained intraoperatively. A pathologist read a rapid-stained smear of the initial aspirate as the procedure was performed and triaged specimens for routine cytologic, cell block and ultrastructural study in solid lesions plus carcinoembryonic antigen (CEA) assay and amylase study in cystic lesions. Purulent material was studied by gram staining and culture. The overall sensitivity in the series was 81%, with a specificity of 100%. No complications were noted. Ultrastructural examination improved the diagnostic accuracy in two cases. Assays for CEA and amylase in "cyst fluids" differentiated true cysts and cystadenocarcinoma from pseudocysts. Maximum utilization of the material aspirated was useful in diagnosing the etiology of solid and cystic pancreatic masses.     

Molluscum contagiosum. A case report with fine needle aspiration cytologic diagnosis and ultrastructural features

BACKGROUND: Cytomorphologic and ultrastructural features of molluscum contagiosum, a rare skin lesion of viral etiology, are presented. CASE: A 4-month-old female was referred for fine needle aspiration cytology of papules over the back and chest wall. A Giemsa-stained preparation of whitish material aspirated from the chest wall nodule showed numerous large, intracytoplasmic, basophilic bodies that pushed the host cell nucleus to the periphery, giving a signet-ring appearance to a few cells. A cytologic diagnosis of molluscum contagiosum was suggested. On electron microscopy numerous intracytoplasmic viral particles were demonstrated, thus confirming the cytologic diagnosis. CONCLUSION: In clinically unsuspected cases, the cytologic diagnosis of molluscum contagiosum can be suggested by demonstrating pathognomonic molluscum bodies in aspirated material.     

Pulmonary hamartomas: cytologic appearances of fine needle aspiration biopsy.

The cytologic findings in specimens obtained from pulmonary hamartomas by fine needle aspiration biopsy are presented. The following are the main characteristics: 1. In spite of the fact that the lesions are usually hard and cartilaginous, find needle aspiration is possible and can obtain diagnostic material. 2. The material obtained usually has few cells. 3. The cells aspirated include columnar ciliated cells, lymphocytes, histiocytes as well as fragments of cartilage which are quite characteristic. 4. The differential diagnosis is discussed.     

Aspiration cytology of breast cysts

A cytologic evaluation was made of 57 samples of fluid aspirated from cystic breast masses during the past 12 years in our hospital. The cytologic diagnosis of the cyst aspirates from 17 cancer cases was positive in 10 cases, suspicious in 2 and negative in 5. No false-positive cytologic diagnosis was made in 40 cases of benign cystic disease. Blood-tinged aspirates were observed in 14 of the 17 cases of malignant cystic disease but in only 2 of 40 benign cases. Ductal cell clusters were detected in aspiration smears from 16 of the cases of malignant cystic disease and 15 of the cases of benign cystic disease. Apocrine cells were seen in the aspiration smears from 12 of the cases of benign cystic disease but in none of the aspirates from the 17 cancer cases.     

Fine Needle Aspiration Cytodiagnosis of Apocrine Carcinoma of the Breast

The cytopathological appearances of 14 cases of apocrine breast carcinoma diagnosed by fine needle aspiration cytology are described and the features compared to those seen in apocrine cells aspirated from benign cystic and solid lesions. Significant atypia must be observed before a diagnosis of apocrine carcinoma can be entertained.     

Fine needle aspiration cytology of mesenchymal hamartoma of the liver. A case report

BACKGROUND: Mesenchymal hamartoma (MH) of the liver constitutes the third or fourth most common tumor of the liver in childhood and occurs most commonly in the first two years of life. MHs of the liver are seldom aspirated, and reports on the role of fine needle aspiration (FNA) in the diagnosis of MH are scarce. Clinically, cytologically and even histologically, MH can be mistaken for a number of reactive and neoplastic hepatic lesions that may occur in children under 2 years of age. CASE: A 10-month-old Pakistani female presented with a history of a right-sided, nonpainful abdominal swelling. Abdominal computed tomography showed a large, partly solid and partly cystic, heterogeneous hepatic mass. FNA cytology showed clusters of both epithelial and mesenchymal/spindle-shaped cells with pieces of loose connective tissue. A cytologic differential diagnosis of mesenchymal hepatic hamartoma and hepatoblastoma of the possible mixed mesenchymal/epithelial subtype was rendered. The histopathologic diagnosis of the resected tumor mass was benign mesenchymal hamartoma of the liver. CONCLUSION: In children under 2 years of age who present with partly solid and partly cystic hepatic masses, the possibility of MH of the liver should be considered. FNA has a role in the diagnosis of MH. The cytopathologist should be aware of the patient's age, radiologic features and cytologic appearances of this rare, benign neoplasm. Histologic examination of tru-cut biopsies and immunohistochemical stains can help to exclude other pediatric neoplasms that may show cytologic features similar to or mimicking those of MH.     

Fine needle aspiration cytology of malignant mesothelioma

The results of fine needle aspiration (FNA) cytology in 19 cases of malignant mesothelioma are presented. Adequate material for a diagnosis of malignancy was obtained in 17 cases, and in 8 cases a specific diagnosis of mesothelioma could be made. In four other cases, the findings were either consistent with or suggestive of mesothelioma; in four, accurate distinction from other neoplasms was not possible, and in two cases, adenocarcinoma was suggested. The spectrum of cytologic findings ranged from neoplasms of purely epithelial appearance through more pleomorphic biphasic neoplasms to anaplastic tumors. A combination of epithelial-like cell clusters, pavement-like sheets of epithelial cells with well-defined cell borders and prominent cell separation, dispersed angular cells with dense cytoplasm and some spindle-cell forms was the most specific cytologic pattern for mesothelioma. In four neoplasms, ultrastructural examination of aspirated material provided the additional evidence for a definitive diagnosis. The identification of hyaluronic acid within intracytoplasmic vacuoles, either in smears or in cell blocks, confirmed the diagnosis in three tumors. Only in one case, with a strong clinical background suggesting mesothelioma, was the cytologic preparation sufficient for diagnosis without ancillary diagnostic methods. FNA is of particular value in the diagnosis of pleural mesothelioma in patients who do not present with a pleural effusion. Obtaining material for cell block preparations, cytochemistry or ultrastructural study is generally necessary for definitive tumor typing.     

Tuberculosis of the intercostal lymph nodes

OBJECTIVE: To describe tuberculosis of the intercostal lymph nodes and discuss its clinical and cytologic profile and pathogenesis. STUDY DESIGN: Fifteen cases from March 1994 to March 2000 were retrieved from our cytology records. Only clinically and therapeutically proven cases were included in the study. RESULTS: The ages of the patients ranged from 4 to 63 years. The male:female ratio was 2:1. The duration of disease at presentation ranged from one week to nine months. The lumps presented either in the parasternal region or between the midclavicular and posterior axillary lines. One case presented with an infrascapular lump. Most of the lumps were ill defined and cystic. Chest radiographs in all cases showed a soft tissue swelling without bony involvement. The aspirates were of two types, blood-mixed particles and necrotic material. Four cytologic pictures were seen: (1) epithelioid cell granulomas alone or (2) with necrosis or (3) with both necrosis and acid-fast bacilli (AFB), or (4) necrosis with AFB. AFB were detected in 53.3% of cases. CONCLUSION: If necrotic material is aspirated or if granulomatous inflammation is encountered in soft tissue swellings of the chest wall, particularly in the parasternal and axillary regions, the possibility of intercostal tuberculous lymphadenitis should be considered.     

Aspiration cytology of the conjunctival surface

OBJECTIVE: To evaluate a method of obtaining conjunctival cells that utilizes aspiration of the conjunctival surface. STUDY DESIGN: Eighteen eyes from 16 patients with epibulbar lesions underwent aspiration of the conjunctival surface using a tuberculin syringe without a needle. The aspirated cells were prepared by the cytocentrifuge or Millipore filter technique. The lesions were subsequently biopsied, and the cytologic and histologic diagnoses were compared. RESULTS: Diagnoses of the conjunctival lesions, in decreasing order of frequency, were conjunctival intraepithelial neoplasia (dysplasia, carcinoma in situ), squamous cell carcinoma, squamous metaplasia, nevus, lymphoma and inflammation. In this feasibility study, the cytologic diagnosis accurately correlated with the histologic diagnosis in most cases. There were two cases in which the cytologic diagnosis led to the correct histologic diagnosis. CONCLUSION: Aspiration cytology of the conjunctival surface is useful in obtaining diagnostic material and may be used as a guide to where a biopsy should be performed. Limitations include inadequate samples and lack of observer experience.     

Fine needle aspiration cytology and immunocytochemistry in a case of intrathoracic thyroid goiter

Fine needle aspiration (FNA) was performed in the case of a patient with an anterior mediastinal mass. Examination of the smears revealed individual and groups of benign nondiagnostic cells. Surgical removal and histologic examination indicated that the mass was a true intrathoracic thyroid goiter. Subsequent immunocytochemical studies on the FNA smears showed thyroglobulin in the cytoplasm of the aspirated cells. The cytologic findings are presented; while not diagnostic of a thyroidal origin in this case, they serve as a reminder of the wide range of cytologic appearances of colloid nodules and goiters. This case will hopefully heighten the awareness of cytologists and other physicians to the consideration of the possibility of intrathoracic goiter in the differential diagnosis of mediastinal lesions seen in fine needle aspirates.     

Fine needle aspiration of schwannomas. Value of electron microscopy and immunocytochemistry in the preoperative diagnosis

In the absence of Verocay bodies, the cytologic appearance of schwannomas can be quite nonspecific, with the differential diagnosis including a number of spindle cell lesions. The diagnostic accuracy can be enhanced by the use of electron microscopy (EM) and immunocytochemistry; both techniques are easily applicable to aspirated material. Six cases of schwannoma, diagnosed as such preoperatively by the application of these techniques, are reported. Only two of the cases showed Verocay bodies on light microscopy. Electron microscopy, performed on four cases, revealed a complex arrangement of long cell processes, with scattered desmosomelike structures, a prominent focally reduplicated basal lamina and long-spacing collagen. All of the cases showed positive staining for S-100 protein.     

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.     

Cytology of bronchial gland carcinoma

The cytologic findings in two adenoid cystic and three mucoepidermoid carcinomas of the bronchial tree are reported. In one case of adenoid cystic carcinoma, the diagnosis was made on a fragment of tumor tissue exfoliated in the patient's sputum. In the other case, brushing and aspirated materials yielded large clusters of small cells arranged around cystlike spaces containing globular basophilic mucuslike material. Fine needle aspirates from the two low-grade mucoepidermoid carcinomas showed clusters of malignant squamous cells containing mucus-secreting cells. The high-grade mucoepidermoid cancer yielded malignant squamous and glandular cells in aspirates.     

Laparoscopic ovum collection in sheep: gross and microscopic evaluation of the ovary and influence on ooctye production

Gross and microscopic evaluations of the ovaries of sheep subjected to successive ovum collection were performed with the objective of identifying if there was interference in oocyte production and morphology of gonads. Gross evaluation of the internal genital tract was also performed. Eighteen ewes of the Santa Inês breed were randomly distributed into three experimental groups of six animals each; G0, G1 and G9 with no, one and nine repetitions, respectively. Estrous synchronization was achieved with a short protocol using MAP followed by single dose stimulation with 80mg of FSHp and 300 IU of eCG (IM). Laparoscopic ovum pick-up was performed 36h later, with 7-day intervals. The number of visualized follicles, aspirated follicles and oocytes recovery was recorded. After the last intervention, ovariectomy was performed for evaluation of gross and microscopical appearance and existence of lesions caused by follicular puncture, which were classified as absent (0), mild (1), moderate (2) and severe (3). The number of visualized follicles, aspirated follicles and oocytes recovery were 13.2±2.0, 11.3±3.0 and 5.8±2.3, respectively, with a recovery rate of 51.7%. No statistical difference was found between the nine sessions (P>0.05). Nine sessions of superovulation and ovum collection procedures did not cause ovarian lesions and did not interfere with the production of follicles in ewes of the Santa Inês breed.     

HIV-1 (p24)-positive multinucleated giant cells in HIV-associated lymphoepithelial lesion of the parotid gland. A report of two cases

BACKGROUND: Cystic benign lymphoepithelial lesion (CBLL) is a well-recognized parotid disorder the diagnosis of which can be made on the basis of clinical findings, human immunodeficiency virus (HIV) testing, image studies and fine needle aspiration (FNA). Most aspirations are cystic, and the lesion can be recognized if the triad of foamy macrophages, lymphoid and epithelial (squamous) cells is observed. CASES: The authors recently observed FNA cytologic features of two HIV-associated cases that exhibited numerous multinucleated giant cells (MGCs) but failed to show the epithelial component. A subsequent surgical resection was performed in one patient. Similarly to what has been described for nasopharyngeal (adenoid and tonsil) lymphoid tissue of HIV-positive patients, intense immunoexpression of S-100 and p24 (HIV-1) protein was present in MGC. CONCLUSION: The diagnosis of HIV-associated CBLL should always be considered if a parotid cystic lesion presents with numerous MGCs. Immunocytochemical detection of p24 (HIV-1) protein in MGC becomes a very useful diagnostic aid and extends to parotid CBLL many of those pathogenic features of HIV-1 infection already noted in other HIV-1-infected, lymphoid oropharyngeal lesions.     

Intraductal papilloma of the salivary gland. A report of two cases with diagnosis by fine needle aspiration biopsy

BACKGROUND: Intraductal papillomas are rare, benign tumors most commonly encountered in minor salivary glands. They are cystic, solitary neoplasms that arise from ductal epithelium and produce painless swellings. CASES: Two cases arose in major salivary glands. The first case was a superficial, firm mass at the superior edge of the parotid, cytologically evocative of an adnexal tumor. A firm, submandibular mass in the second case was diagnosed as a papillary neoplasm. Fluid was aspirated from both cases. Three-dimensional epithelial clusters, some with a papillary configuration and histiocytes, were the main cellular components. The majority of cells showed oncocytic differentiation; however, benign-appearing ductal cells in honeycomb sheets were also present. The first case also had occasional cells suggestive of sebaceous differentiation. The excised lesions were unilocular cystic papillary neoplasms consistent with intraductal papilloma; focal sebaceous differentiation was noted in the first case. CONCLUSION: Awareness of the cytologic features of intraductal papilloma of the salivary glands should prompt its inclusion in the differential diagnosis of papillary lesions of the head and neck.     

The utility of assessing the gross appearances of FNA specimens

F. Mayall, A. Cormack, S. Slater and K. McAnulty The utility of assessing the gross appearances of FNA specimens Objective: Ideally, fine needle aspiration (FNA) cytology should be performed with near‐patient assessment of the adequacy of the specimen by a cytopathologist. However, this is often not feasible. A cruder alternative is for the FNA practitioner to examine the gross appearances of the specimen and to try to predict the its quality. This study set out to determine the value of this approach. Methods: The study was conducted in tertiary public hospitals in New Zealand and the UK. FNA gross material grading was performed by a variety of pathologists on FNA samples taken using manual guidance and image guidance. The FNA gross material grade was compared with the findings on microscopic examination. Results: Nine out of 123 FNA samples were assessed as Grade 1 (unlikely to contain diagnostic material). All were subsequently reported as having insufficient diagnostic tissue on microscopic examination. Forty‐two of the FNA samples were assessed as Grade 2 (possibly contains diagnostic material) and 46 as Grade 3 (probably contains diagnostic material). None from either of these grades was reported as showing insufficient diagnostic material on microscopic examination. Twenty‐six cases were reported as Grade 4 (material suggesting a specific diagnosis). None of these was reported as showing insufficient diagnostic material on microscopic examination. The most common Grade 4 provisional diagnosis was that of a colloid cyst or colloid nodule of the thyroid (seven cases). Only two cases had misleading Grade 4 provisional diagnoses. Both were thought to be pus on gross examination but showed necrotic carcinoma on microscopic examination. Conclusions: The gross appearances of FNA samples can usually predict the adequacy of the samples and sometimes predict the final microscopic diagnosis. However, near‐patient microscopic assessment of FNA specimens is preferable if available.