Fine needle aspiration cytology of pulmonary infarct

The cytologic features of a pulmonary infarct diagnosed by fine needle aspiration (FNA) cytology are reported in a 54-year-old white man with a prior history of renal transplant surgery. Although the diagnosis of pulmonary embolus was unsuspected, FNA cytology suggested the correct diagnosis, which was confirmed by subsequent radiologic studies. This is believed to be the first reported case of pulmonary infarct diagnosed by FNA cytology. Cytologic features of the entity are discussed along with potential sources for a false-positive diagnosis of malignancy.     

Fine needle aspiration cytology of tuberculosis of the lumbar vertebrae (Pott's disease)

The cytomorphologic features of tuberculosis of the lumbar vertebra having a granulomatous pattern diagnosed by fine needle aspiration (FNA) biopsy are reported in a 72-year-old woman with a prior history of malignant lymphoma treated by chemotherapy. Cytologic examination revealed microtissue fragments of cohesive cells, including epithelioid histiocytes and scattered, multinucleated Langhans-type giant cells. This is believed to be the first reported case of vertebral tuberculosis (Pott's disease) diagnosed by FNA cytology and confirmed by culture of the aspirate material. This case illustrates the value of FNA cytology in the diagnosis of nonneoplastic skeletal lesions and confirms the value of FNA biopsy the early detection of infectious processes in patients with malignancy.     

Hepatic and subcutaneous abscesses due to aspergillosis. Initial diagnosis of a case by intraoperative fine needle aspiration cytology

Laparotomy of a 64-year-old woman with bleeding caused by a perforated anastomotic peptic gastric ulcer disclosed a mycotic abscess in the lower surface of the left hepatic lobe covering the ulcer. Fine needle aspiration (FNA) of the abscess produced a clear milky liquid that was positive for Aspergillus fungi by cytology and subsequent microbiologic and cultural studies. Postoperative diffusion of the aspergillosis into the subcutaneous tissue was similarly confirmed by cytology and Sabouraud solid medium culture. This appears to be the first case of disseminated aspergillosis diagnosed by intraoperative FNA cytology; it confirms that FNA cytology is a rapid, sensitive and important tool for the diagnosis of mycotic infections.     

Diagnosis of cutaneous leishmaniasis by fine needle aspiration cytology. Report of a case

A case of cutaneous leishmaniasis diagnosed by means of fine needle aspiration (FNA) cytology is presented. The pathognomonic cytopathologic picture consisted of lymphocytes, plasma cells and epithelioid granulomas intermingled with histiocytes. Numerous Leishmania organisms were observed within the histiocytes and extracellularly. This case emphasizes the utility of FNA cytology in diagnosing lesions of the skin.     

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.     

Mixed apocrine-medullary carcinoma of the breast. Report of a case with fine needle aspiration cytology

The case of an unusual variant of breast carcinoma arising in an 80-year-old woman is presented. Fine needle aspiration (FNA) cytology of this carcinoma revealed sheets of cells showing apocrine differentiation and significant cellular atypia mixed with lymphocytes and plasma cells. At mastectomy, the neoplasm was found to have features of both apocrine carcinoma and medullary carcinoma, with a prominent lymphocytic infiltrate. This case underlines the difficulty in distinguishing between malignant apocrine cells and apocrine metaplastic cells by FNA cytology. The presence of an inflammatory component, as seen in this case, may compound such difficulties.     

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.     

Fine needle aspiration cytology of malignant spiradenoma arising in congenital eccrine spiradenoma

The fine needle aspiration (FNA) cytology of malignant eccrine spiradenoma arising in a large benign congenital eccrine spiradenoma is described. The malignant tumor was characterized by cohesive, pleomorphic cells with malignant nuclear features and numerous mitoses. FNA of the adjacent benign eccrine spiradenoma revealed prominent basement membrane deposition with an irregular tubular and nesting growth pattern and bland basaloid cells. To our knowledge, the FNA of malignant eccrine spiradenoma has not been previously described. In this case, FNA cytology was influential in directing patient management.     

Fine needle aspiration cytology of metastatic malignant rhabdoid tumor

The diagnosis and management of pediatric neoplasms using fine needle aspiration (FNA) has been neglected as compared to neoplasms occurring in adults. A case of metastatic malignant rhabdoid tumor diagnosed by FNA cytology is presented, and the cytologic morphology, which to our knowledge has not previously been reported, is described. The ultrastructural findings in the histologic specimen are also depicted. This case demonstrates the feasibility and need for further exploration of the use of FNA in pediatric oncology.     

Metastatic tumors in fine needle aspiration biopsy of the thyroid

A series of almost 25,000 thyroids examined by fine needle aspiration (FNA) biopsy was reviewed to ascertain the incidence and presentation of metastatic cancers in thyroid FNA samples. Metastatic cancers in FNA samples from the thyroid were identified in 25 cases (0.1%); the primary tumors were carcinomas of the kidney (8 cases), lung (7 cases), breast (5 cases), cervix uteri (1 case) and colon (1 case) and 1 case each of malignant melanoma, malignant pleural mesothelioma and rhabdomyosarcoma. FNA cytology was positive in all 25 cases. In 11 cases, the primary tumor was clinically known at the time of FNA biopsy; of the other 14 cases, cytology suggested that the malignancy was metastatic in only 5. Metastases of renal and mammary adenocarcinomas were almost indistinguishable from follicular and papillary thyroid carcinomas on cytologic grounds. The results demonstrate the rarity of this finding and the difficulty of diagnosing a metastatic tumor in the thyroid by FNA biopsy, in the absence of a clinical history of a prior primary neoplasm.     

Fine needle aspiration cytology of hepatic metastasis from a meningeal hemangiopericytoma. A case report

BACKGROUND: Hemangiopericytomas (HPCs) are rare spindle cell tumors, constituting 2.5% of soft tissue neoplasms. Few reports have addressed the fine needle aspiration (FNA) cytology of HPC. CASE: We describe the FNA biopsy (FNAB) findings in a 44-year-old patient with a previously resected meningeal hemangiopericytoma. The patient underwent ultrasound-guided FNAB of a 16.0-cm, radiographically heterogeneous density in the liver. The FNA smear showed crowded, ovoid to spindle-shaped cells with poorly defined, scant cytoplasm. The neoplastic cells were positive for CD34 and negative for CD31, factor VIII, glial fibrillary acid protein and cytokeratin AE1/AE3, supporting a diagnosis of HPC and compatible with metastasis from the patient's cerebral tumor. CONCLUSION: This case documents the role of FNA cytology in confirming HPC.     

Fine needle aspiration biopsy of azoospermic testes. Could it replace histologic biopsy?

OBJECTIVE: To evaluate the possibility of replacing histologic biopsy of azoospermic testes by fine needle aspiration (FNA) for diagnostic and management purposes. STUDY DESIGN: Twenty-seven patients were examined under general anesthesia, and 53 testes were biopsied by FNA. Fifty-four testes were biopsied for histologic examination. Histology and cytology of each testis were compared to assess the discrepancy or concordance between the diagnoses. RESULTS: Twenty-seven testes showed complete concordance of cytology and histology, and 13 testes showed a mild degree of discrepancy. A severe degree of discrepancy was seen in 13 testes. In the majority of discrepant cases, FNA biopsy diagnosis was more sensitive in detecting evidence of full or advanced maturation. In one case of discrepancy, the histologic finding was Sertoli cells only, and cytology revealed focal full maturation. In vitro fertilization using sperm from this case was successful. CONCLUSION: FNA biopsy of testes in azoospermia is a fast, reliable and minimally traumatic method. The prospects for utilizing FNA biopsy material in assisted and microassisted fertilization are promising.     

Comparison of diagnostic results obtained by fine needle aspiration cytology and tru-cut or open biopsies

In seven cases fine needle aspiration (FNA) cytology provided a diagnosis of neoplasm when the Tru-Cut (TC) tissue biopsies (four cases) and open biopsies (three cases) were negative. The specimens consisted of two breast carcinomas, two metastatic neoplasms in the liver, one metastatic melanoma in inguinal lymph nodes, a retroperitoneal mass and a pelvic mass. In the two cases of mammary carcinoma, TC biopsies were negative and FNAs were diagnostic of carcinoma. TC biopsies in the two cases of questionable hepatic metastasis were negative, but FNAs demonstrated a malignant neoplasm. Open biopsy of a retroperitoneal mass failed to diagnose a neoplasm however, subsequent ultrasound-directed FNA demonstrated a neoplasm, possibly seminoma. FNA cytology of inguinal lymph nodes in one case was diagnostic of melanoma; open biopsy showed no neoplasm. Because of the FNA diagnosis, additional sections were made and the presence of melanoma was confirmed. This series demonstrates that FNA cytology should be considered the initial diagnostic procedure more often.     

Cytologic diagnosis of metastatic hepatocellular carcinoma presenting as an orbital mass. A case report

BACKGROUND: Hepatocellular carcinoma (HCC) metastasizing to the orbit is extremely rare. In the 13 cases reported in the English-langnage literature, the diagnosis was confirmed by fine needle aspiration (FNA) cytology only once. This is the second such case to be diagnosed by FNA cytology and the first to be reported from the Indian subcontinent. CASE: A 76-year-old woman presented with progressive proptosis, bulging of the globe and loss of vision in the right eye. Clinical and radiologic evidence favored a primary orbital tumor with liver metastasis. Cytologic examination of aspirated material from the orbital and liver masses showed features similar to those of HCC. CONCLUSION: Recognition of the cytologic features of HCC permits its diagnosis in metastatic sites. FNA can be employed as an effective tool for diagnosing HCC at metastatic sites, especially when biopsy is technically difficult.     

Fine needle aspiration cytology of mammary duct ectasia: report of a case with novel cytologic and immunocytochemical findings.

BACKGROUND: Mammary duct ectasia (MDE), or periductal mastitis, is a well-defined clinical entity with a characteristic histopathologic appearance on breast biopsy specimens. However, the cytologic features of MDE have been described only recently in the cytopathology literature, and fine needle aspiration (FNA) cytologic findings are based mainly on a small number of case reports in the English-language literature. Therefore, awareness of this entity and recognition of its cytomorphologic features could aid in a more accurate diagnosis. We report the novel cytologic and immunocytochemical findings on a case of MDE that was confirmed by histologic examination on a subsequent biopsy. CASE: We report the findings of breast FNA cytology in a 50-year-old female with a mammographically and clinically suspicious lesion. Cytology displayed a paucicellular aspirate, typified by a few scattered, cohesive clusters of ductal epithelial cells with mild nuclear atypia and distinct, peripherally located myoepithelial cells. Intermingled within the ductal elements were numerous polygonal cells with abundant, finely vacuolated cytoplasm that were immunoreactive for macrophage-specific antibody, CD68. The background consisted of a variable number of foam cells and negligible amount of blood. CONCLUSION: The current case of MDE demonstrates cytomorphologic features that may pose diagnostic problems, particularly as a consequence of variable cytologic atypia this entity may present on FNA cytology. This diagnostic difficulty is compounded because of the abnormal mammographic and suspicious clinical findings that may be associated with MDE. CD68 immunoreactivity is a useful ancillary tool to verify the histiocytic, rather than epithelial and potentially neoplastic, nature of multivacuolated cells. To the best of our knowledge, there has been no prior reported case of MDE in the English-language literature studied utilizing CD68 antibody. This case report emphasizes that MDE is a heterogeneous entity with diverse cytomorphologic features. FNA cytology in conjunction with immunocytochemistry might permit accurate classification in the proper clinical setting.     

Necrosis of a Warthin's tumor following fine needle aspiration

Fine needle aspiration (FNA) biopsy of a parotid mass demonstrated features diagnostic of a Warthin's tumor. Resection of the mass six weeks later yielded a necrotic nodule lacking distinguishing characteristics. This case illustrates infarction of the target lesion, a rare complication of FNA biopsy of salivary gland neoplasms. Correlation of the histology with the cytology will prevent diagnostic difficulties in such instances.     

Parathyroid carcinoma with occult bone metastases diagnosed by fine needle aspiration cytology

A case with persistent hypercalcemia following complete resection of a primary parathyroid carcinoma is presented. An occult bone metastasis was diagnosed by fine needle aspiration (FNA) cytology of a lytic bone lesion clinically presumed to be a "brown tumor" of hyperparathyroidism. The cytologic features of the metastatic lesion were similar to those of the resected primary lesion and of a previously identified metastasis. The potential usefulness of FNA cytology in this clinical setting is discussed.     

Cementifying fibroma diagnosed by fine needle aspiration cytology. A case report.

A case of cementifying fibroma in the right lateral mandible was diagnosed by fine needle aspiration (FNA) cytology. The aspirate was a cellular specimen composed of clusters of oval and spindle-shaped fibroblasts with no atypical features. These cells were admixed with spherical, calcified structures. A diagnosis of "consistent with benign fibroosseous lesion, suggestive of cementoossifying fibroma" was made, and subsequent histologic examination confirmed this cytologic diagnosis. The clinical, cytologic and histologic findings in the case are presented, and the value of FNA cytology in the diagnosis of jaw lesions is discussed.     

Cytology of melanotic schwannoma in a fine needle aspirate and pleural fluid. A case report

BACKGROUND: Melanotic schwannoma (MS) is a rare pigmented neural tumor most commonly occurring in the paraspinal region and involving spinal nerve roots and sympathetic ganglia. Few case reports describe the fine needle aspiration (FNA) cytology of MS. We report an additional case and for the first time describe the cytologic findings of MS in pleural fluid. CASE: A 44-year-old man presented with a 9.0-cm paraspinal mass associated with multiple lung nodules. FNA cytology of the paraspinal mass showed solitary and syncytially arranged spindled cells, with prominent nucleoli and variable amounts of cytoplasmic brown pigment. In pleural fluid, prominent isolated single cells were rounded and had a signet ring cell morphology. Tumor cells in both the aspirate and pleural fluid expressed S-100 protein and HMB-45. CONCLUSION: The FNA cytology findings of MS correlate well with the histologic findings. In pleural fluid, however, the cells are epithelioid, and some have a signet ring morphology, mimicking adenocarcinoma.