Ameloblastic fibroma. Report of a case with fine needle aspiration cytologic findings.

A case of ameloblastic fibroma of the jaw in an 18-year-old patient is presented. Fine needle aspiration cytologic smears showed two different types of cellular elements: a glandlike epithelial component, arranged in bidimensional, well-outlined clusters of basaloid cells with palisading of the columnar cells at the borders of those clusters, and a mesenchymal component that consisted of loosely arranged fusiform cells. These cytologic features appear to be sufficiently characteristic to suggest a diagnosis of ameloblastic fibroma by fine needle aspiration.     

Renal collecting duct carcinoma. Report of a case with cytologic findings on fine needle aspiration

BACKGROUND: Collecting duct carcinoma (CDC) of the kidney is a rare type of renal cell carcinoma (RCC) of collecting duct origin. Cytologic differentiation of CDC from conventional RCC is important because CDC has a poorer prognosis than the latter. CASE: A 60-year-old male incidentally demonstrated a left renal mass that was hypovascular by angiography. Fine needle aspiration (FNA) revealed numerous clusters of cells arranged in a tubular structure. The cells consisted of highly atypical cells having large nuclei with coarse or vesicular chromatin, prominent nucleoli and lacy or granular cytoplasm. Based on these findings, which were indicative of high grade RCC, he underwent left radical nephrectomy and lymphadenectomy. Histologic and immunohistochemical findings, including anti-high-molecular-weight cytokeratin (HMCK) antibody, confirmed the diagnosis of CDC. CONCLUSION: CDC should be added to the differential diagnosis when the result of cytologic examination of a renal mass is suggestive of high grade RCC. These features of FNA smears, together with HMCK immunohistochemistry, can be useful for the cytologic differential diagnosis of renal tumors.     

Neonatal juvenile xanthogranuloma. Report of a case with fine needle aspiration cytologic findings in a soft tissue mass

BACKGROUND: Juvenile xanthogranuloma is an infrequent, benign histiocytic lesion, the recognition and diagnosis of which by fine needle aspiration biopsy are important for ascertaining whether a case will have a benign course or spontaneous regression. CASE: A case of juvenile xanthogranuloma was located in the upper lip of a newborn male. CONCLUSION: Juvenile xanthogranuloma has characteristic cytologic features that may allow recognition in fine needle aspiration cytology smears.     

Prayer nodules fine needle aspiration cytologic findings

The enlarged prayer nodules from five patients were aspirated for cytologic studies. The fine needle aspiration yielded a cheesy material that showed keratin plaques and hair fragments. The cytologic interpretation of the nodules as multiple epidermoid cysts was confirmed by subsequent histologic study.     

Malacoplakia of the pelvis. Report of a case with cytologic and ultrastructural findings obtained by fine needle aspiration.

Malacoplakia is a rare granulomatous, inflammatory disease usually diagnosed on a biopsy specimen. Only five cases have been diagnosed by FNA, most of them in the prostate. We report the cytologic and ultrastructural findings in fine needle aspirates of pelvic malacoplakia. The main characteristic of the smears was a richly inflammatory background with abundant, foamy histiocytes containing Michaelis-Gutmann bodies. The results indicate that fine needle aspiration is useful in diagnosing this disease, excluding a neoplastic process and performing follow-up.     

Primary giant cell tumor of soft tissue. Report of a case with fine needle aspiration cytologic and histologic findings

BACKGROUND: So-called primary giant cell tumor of soft tissue of low malignant potential is the rare soft tissue analogue of giant cell tumor of bone, occurring primarily in superficial soft tissue. To our knowledge, the cytologic findings in bulky giant cell tumor of deep soft tissue were described only once, and no further report on the subcutaneous giant cell tumor could be retrieved from the literature. CASE: A 58-year-old woman presented with a well-demarcated, 1.5-cm-diameter dermal tumor. Fine needle aspiration smears contained numerous osteoclastlike giant cells and mononuclear cells showing bland and vesicular nuclei. A small fragment of branching vasculature and 1 mitosis were found. Those cytologic findings were enough to suggest a diagnosis of giant cell tumor of soft tissue, confirmed as a deep dermal giant cell on surgical resection. CONCLUSION: Primary giant cell tumor of soft tissue of low malignant potential should be considered in the differential diagnosis of bland-looking giant cell-rich lesions. Awareness of its existence and knowledge of its cytologic features are important for a correct preoperative cytologic diagnosis.     

Ectopic hamartomatous thymoma. Report of a case with fine needle aspiration biopsy findings

BACKGROUND: Ectopic hamartomatous thymoma is a rare, benign tumor occurring exclusively in the supraclavicular and suprasternal regions. To the best of our knowledge, there are no English-language reports on its cytologic findings. CASE: A fine needle aspiration specimen from a mass in the suprasternal region in a 63-year-old male revealed epithelial cell nests, spindle cells, a cluster of mature adipocytes and a small number of lymphocytes. CONCLUSION: Although ectopic hamartomatous thymoma is very rare, fine needle aspiration cytology may contribute to the correct diagnosis in conjunction with the characteristic clinical findings.     

Inflammatory pseudotumor of the liver. Report of the fine needle aspiration cytologic findings in a case initially misdiagnosed as malignant

The fine needle aspiration (FNA) cytologic features are described in a case of inflammatory pseudotumor of the liver (xanthogranuloma), a disease generally regarded as of unknown etiology. The initial FNA findings were those of an acute exudative process, with atypical biliary duct epithelium and hepatocytes. These were interpreted as verifying the radiologic impression of a malignancy. Histologic study of subsequently resected nodules revealed the true nature of the case. As the lesion evolved, granulomatous inflammation supervened, characterized by numerous foamy histiocytes and lesser populations of plasma cells and lymphocytes. Numerous gram-positive cocci were readily demonstrated, suggesting that the lesion was an unusual tissue response to an intrahepatic bacterial infection. The lesion eventually resolved with prolonged antibiotic therapy.     

Breast myeloma: a report of 3 cases with fine needle aspiration cytologic findings

BACKGROUND: Multiple myeloma of the breast is very rare, and the fine needle aspiration (FNA) findings have not been reported before. CASES: Two cases of multiple myeloma presented with bilateral breast nodules during treatment with chemotherapy. One case of multiple myeloma presented initially with a left breast mass. FNA smears of all 3 cases revealed numerous plasma cells, plasmablasts and multinucleated giant plasma cells. The smears were diagnosed as plasma cell tumors. Serum immunoelectrophoresis revealed IgG myeloma in 2 cases and IgA myeloma in 1. Marrow aspirates revealed > 30% plasma cells. Two patients died, and 1 was alive at this writing. CONCLUSION: The aspiration cytology findings of myeloma can be confuse, with primary and secondary tumors of the breast. The previous clinical history and ancillary studies, such as bone marrow study and serum immunoelectrophoresis, are essential to the correct diagnosis.     

Signet-ring follicular adenoma of the thyroid diagnosed by fine needle aspiration. Report of a case with cytologic description

BACKGROUND: Follicular cells of the thyroid may undergo squamous, oncocytic or clear cell metaplastic changes. Of these, the clear cell change with signet-ring formation is the most unusual, and follicular adenoma of the thyroid with signet-ring formation is extremely rare. We describe for the first time the cytologic features of a clear cell adenoma of the thyroid obtained by fine needle aspiration (FNA). CASE: A 48-year-old woman in a euthyroid state presented with a 2-cm, right-sided thyroid nodule. Smears obtained by FNA of the nodule revealed clusters of large signet-ring cells in a bloody background. The signet-ring cells were round to oval, with large cytoplasmic vacuoles and hyperchromatic, eccentric nuclei. Colloid in the background was very scanty. Histologic examination of the right hemithyroidectomy specimen revealed a signet-ring follicular adenoma. CONCLUSION: Lack of familiarity with signet-ring cell adenoma of the thyroid could lead to an erroneous diagnosis of metastatic signet-ring cell carcinoma.     

Epithelioid sarcoma. Report of a case with fine needle aspiration diagnosis

BACKGROUND: Epithelioid sarcoma is a rare type of soft tissue sarcoma affecting the extremities, particularly the hands and fingers. Though it is well described histopathologically, publications regarding its cytologic findings are limited. CASE: A 52-year-old woman presented with swelling of the left middle finger. Fine needle aspiration was performed. Smears showed oval to polygonal cells with epithelioid features. A diagnosis of soft tissue sarcoma with a possibility of epithelioid sarcoma was suggested. Histopathologic examination and immunohistochemistry confirmed the diagnosis. CONCLUSION: In the presence of classic cytologic findings, the diagnosis of epithelioid sarcoma can be suggested. Subsequent histologic examination and immunohistochemistry can confirm the diagnosis.     

Actinomycotic mycetoma. Report of a case with diagnosis by fine needle aspiration

Mycetoma (madura foot, maduromycosis) is present worldwide but more so in the tropics. We report a case of actinomycetoma diagnosed by fine needle aspiration using cell smears. The authors believe it to be the first case so diagnosed. Definitive diagnosis of the etiologic agent is made by culture, leading to a delay in institution of treatment. The authors advocate the use of fine needle aspiration for rapid diagnosis, thus instigating further workup and treatment.     

Spindle cell lipoma of the oral cavity. Report of a rare intramuscular case with fine needle aspiration findings

BACKGROUND: Spindle cell lipoma (SCL) is a benign neoplasm characterized by a mixture of mature fat, bland spindle cells and wiry collagen in a variably myxoid background. Oral SCLs are rare, and only four cases of intramuscular SCL exist in the literature. We report the first case of intramuscular SCL of the oral cavity with fine needle aspiration (FNA) findings. CASE: A 61-year-old woman presented with a 3-cm mass in the right gingivobuccal sulcus. Papanicolaoustained FNA smears were hypocellular and contained loose collections of spindle cells in a myxoid background, numerous mast cells, rare capillary fragments and portions of skeletal muscle. The spindle cells had mild nuclear enlargement, focal nuclear irregularities, rare intranuclear inclusions and occasional small nucleoli. No lipoblasts or mitoses were identified. There was intermingling of the spindle cells with the skeletal muscle fragments. CONCLUSION: Intraoral SCL is a rare lesion but should be considered in the differential for a benign spindle cell neoplasm in the oral cavity. Clues to diagnosis on cytology include mature fat, bland spindle cells, a myxoid background and mast cells.     

Oral leiomyosarcoma in childhood. Report of a case with fine needle aspiration cytology

BACKGROUND: Leiomyosarcomas are rare tumors in the pediatric age group, and occurrence of this neoplasm in the oral cavity is exceedingly rare. This article highlights the fine needle aspiration (FNA) cytology diagnosis of a case of recurrent oral leiomyosarcoma in childhood. CASE: An 11-year-old male noticed a swelling in the oral cavity near the left lower jaw. It was excised and diagnosed as leiomyosarcoma on histopathology. Four months later the patient presented with a progressive swelling in the oral cavity that extended to the lower jaw. The recurrent swelling was subjected to FNA, and its cytologic features were consistent with leiomyosarcoma. There was a very good initial response to chemotherapy and radiation therapy. However, because of noncompliance with advice for further therapy, the patient had a second local recurrence and dissemination of the disease to the skeletal system, abdomen and thorax. FNA cytology diagnosis of the second locally recurrent lesion and abdominal mass were consistent with leiomyosarcoma. Immunocytochemical staining revealed a positive reaction in the cytoplasm of tumor cells for vimentin and desmin in the FNA smear and paraffin section, respectively. CONCLUSION: Fine needle aspiration cytology is a useful technique for detection of recurrence and metastasis during follow-up of childhood oral leiomyosarcoma.     

Idiopathic granulomatous mastitis. Report of a case diagnosed with fine needle aspiration cytology.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a benign, inflammatory breast disease of unknown etiology. Although it is rare, it frequently presents in a manner similar to that of breast carcinoma. CASE: A 41-year-old female developed unilateral idiopathic granulomatous mastitis, diagnosed by fine needle aspiration cytology. The clinical presentation and mammographic findings were suspicious for carcinoma. Fine needle aspiration cytology showed granulomatous inflammation. Histopathologic examination revealed a noncaseating, granulomatous lesion. Further clinical, radiologic and laboratory investigations disclosed no etiology. Therefore, we considered the case to be idiopathic granulomatous mastitis. CONCLUSION: Cytologically it may be difficult to distinguish IGM from carcinoma of the breast. Typical cytologic findings of the lesion are helpful to rule out cancer. In the differential diagnosis, all known causes of granulomatous changes have to be excluded before a diagnosis of idiopathic granulomatous mastitis is made.     

Pulmonary sclerosing hemangioma. Report of a case with diagnosis by fine needle aspiration.

Sclerosing hemangioma is a rare but well-recognized benign lesion of the lung. We report a case of pulmonary sclerosing hemangioma correctly diagnosed by fine needle aspiration (FNA) cytology. The sharp and smooth contour of the discrete mass in the left lower zone of the chest roentgenogram raised the possibility of a benign lesion, including pulmonary sclerosing hemangioma. The characteristic "blood spaces" with surrounding regular, bland polygonal tumor cells in the FNA smears provided an essential clue to the diagnosis of sclerosing hemangioma. It was confirmed by Surecut biopsy of the lesion. The patient remained well one year after the investigation and was spared an unnecessary diagnostic thoracotomy. The cytologic features and differential diagnoses of pulmonary sclerosing hemangioma are discussed. Besides delineating the cytologic characteristics of pulmonary sclerosing hemangioma, this case illustrates the importance of a careful clinicopathologic correlation, which should be exercised by the cytopathologist in all instances.     

Pulmonary paragonimiasis. Report of a case with diagnosis by fine needle aspiration cytology.

We report a case of paragonimiasis in a Nigerian woman evaluated for symptoms of chronic respiratory disease five years after chemotherapy for primary lymphoma of the breast. Fine needle aspiration of one of two fibrocavitary pulmonary lesions yielded thick, brown material in which ova diagnostic of Paragonimus westermani were identified cytologically. This disease is unusual in natives of North America but is seen in travelers and immigrants from Asia, Africa, and South and Central America, where it is endemic. The infection can be fatal, especially if it involves the central nervous system. The clinical differential is broad, but an accurate diagnosis may be made by fine needle aspiration, thus allowing proper treatment.     

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.