Bronchial brushing cytology features of primary malignant fibrous histiocytoma of the lung. A case report

BACKGROUND: Malignant fibrous histiocytoma (MFH) of the lung is rare. Early diagnosis is very important because of its poor prognosis. Long-term survivors of pulmonary MFH are patients who had surgical resection. When the patient can undergo surgery after a prompt diagnosis, the prognosis improves more than with other therapy. However, it is not easy to establish the diagnosis of thoracic MFH. In general, the small fragments from bronchial or percutaneous transthoracic fine needle aspiration (FNA) biopsies are inadequate for cytologic or pathologic analysis. Bronchial brushing cytology is greatly superior to FNA cytology because one can obtain a large amount of cells. Therefore, bronchial brushing cytology may play a useful role in diagnosis when endobronchial involvement is found. CASE: A 65-year-old female was admitted with a cough, yellow sputum and exertional dyspnea. A chest roentgenogram showed a 12 x 12-cm mass in the left lung field. Bronchial brushing cytology revealed many fibroblastlike, histiocytelike, bizarre and multinucleated giant cells in a background of necrosis. Atypical mitotic figures were also found. The cytologic findings strongly suggested MFH. Although the pathologic findings from FNA biopsy showed storiform clusters structured by pleomorphic, fibroblastlike cells with bizarre nuclei and mitotic figures, the material was too small to diagnose it definitively. Six months later the patient died. An autopsy confirmed the diagnosis of MFH: the typical storiform clusters were composed of many fibroblastlike and histiocytelike cells that were positive for CD68 (PGM1) antibody. CONCLUSION: Bronchial brushing cytology may be a useful method for early, definitive diagnosis of MFH. The presence of pleomorphic, spindle-shaped fibroblastlike and histiocytelike cells with the clusters showing a storiform pattern may permit the diagnosis of MFH.     

Endoscopic brushing cytology of primary gastric choriocarcinoma. A case report.

A rare primary choriocarcinoma of the stomach developed in a 71-year-old woman admitted with epigastric pain and weight loss. Brushing smears revealed highly atypical malignant cells with bizarre nuclei and prominent nucleoli. Multiple histologic sections revealed pure choriocarcinoma. Human chorionic gonadotropin and keratin were demonstrated in malignant cells by immunohistochemistry.     

Neuroendocrine carcinoma of the pancreas diagnosed by aspiration cytology. A case report

Cytologic criteria for distinguishing endocrine from exocrine carcinomas of the pancreas have not been previously elucidated. A case is presented in which the diagnosis of neuroendocrine carcinoma was made on fine needle aspirates of a pancreatic mass and hepatic metastases in a 33-year-old female. Cytologically, the aspirated tumor resembled an intermediate-cell neuroendocrine carcinoma of the lung rather than the usual duct-cell adenocarcinoma of the pancreas. Histologic sections of the subsequently resected primary pancreatic mass revealed a neuroendocrine carcinoma of an intermediate-cell type. Ultrastructurally, the characteristic interlacing cytoplasmic processes with scanty granules were seen. Immunoreactive neuron-specific enolase (NSE), leuenkephalin, substance P and somatostatin were present in the tumor cells in Bouin's-fixed cell blocks of the aspirate; neuron-specific enolase, somatostatin and gastrin were detected in the paraffin-embedded sections of the resected tumor. This variant of pancreatic carcinoma merits recognition as a cytologically distinct group, which shares many of the features described in its bronchopulmonary and gastrointestinal counterparts.     

Pulmonary mucormycosis diagnosed by fine needle aspiration cytology. A case report

BACKGROUND: The usefulness of fine needle aspiration cytology (FNAC) in the diagnosis of lung lesions is well documented. Fungal lesions are among nonneoplastic lesions of the lung in which FNAC has proven a useful technique in both immunocompromised and immunocompetent patients. These include cryptococcosis, aspergillosis, histoplasmosis and coccidiodomycosis. Pulmonary mucormycosis, an aggressive fungal infection, is rarely diagnosed on FNAC. We report a case of isolated pulmonary mucormycosis diagnosed on FNAC. CASE: A 62-year-old renal transplant recipient with diabetes mellitus and hypertension, asymptomatic for four months, presented with tachypnea, generalized malaise and weakness. Radiologic studies showed an enlarging, cavitating lesion in the right lung. Computed tomography-guided fine needle aspiration performed on the lung lesion showed fungal profiles with broad, ribbonlike, aseptate hyphae with right-angled branching consistent with the Zygomycetes class of fungi, which includes Rhizopus and Mucor species. Fungal cultures confirmed the presence of Rhizopus. The patient underwent right pneumonectomy, was placed on liposomal amphotericin B therapy and discharged with good pulmonary status and stable kidney function. CONCLUSION: FNAC is a useful technique in the diagnosis of pulmonary mucormycosis.     

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.     

Extramedullary hematopoiesis of the thyroid gland diagnosed by FNA cytology. A case report

BACKGROUND: Extramedullary hematopoiesis (EMH) is the production of elements of erythroid and myeloid series at ectopic sites; when concomitant with agnogenic myeloid metaplasia, it is invariably seen in advanced disease. In EMH, involvement of the thyroid gland is extremely rare. CASE: An 82-year-old male with thyroid enlargement underwent fine needle aspiration (FNA) cytology with a diagnosis of malignancy. A month later another FNA cytology was performed and was consistent with EMH. A complete hematologic workup subsequently allowed the diagnosis of agnogenic myeloid metaplasia. CONCLUSION: The presence of EMH in the thyroid gland is an unusual finding, and, due to the presence of numerous giant cells, the cytologic presentation might be mistaken for anaplastic thyroid carcinoma. The differential diagnosis is based on the recognition of giant cells as megakaryocytes.     

Inflammatory pseudotumor of the parotid gland: report of a case with fine needle aspiration cytology

BACKGROUND: Inflammatory pseudotumor is a rare lesion of the parotid gland. It usually presents as a mass lesion; thus, the clinical and radiologicfeatures often suggest malignancy. To the best of our knowledge, fine needle aspiration cytologic findings in parotid inflammatory pseudotumor have not been reported previously. CASE: A 59-year-old male presented with a palpable right parotid mass. Computed tomography revealed a mass measuring 2.5 cm in diameter. Fine needle aspiration cytology showed inflammatory cells, foamy histiocytes and groups of spindle-shaped cells without cytologic atypia. A diagnosis of inflammatory pseudotumor was suggested and was confirmed on histology. CONCLUSION: In the presence of a clinically evident mass in the parotid gland and fine needle aspiration cytologic features of inflammatory cells with sheets of spindle cells, the diagnosis of inflammatory pseudotumor should be suspected. The differential diagnosis of this unusual parotid gland lesion principally includes sialadenitis and myoepithelioma.     

Primary malignant lymphoma of the uterine corpus diagnosed by endometrial cytology. A case report

BACKGROUND: A relatively small number of cases of primary malignant lymphoma of the uterine corpus have been reported, and it is rare for cases to be preoperatively diagnosed by cytology. CASE: A 59-year-old female experienced abnormal uterine bleeding of two months' duration. Preoperative evaluation of endometrial cytology revealed malignant cells. These cells demonstrated a rather round or oval configuration, with a markedly increased nuclear/cytoplasmic ratio, and were isolated and scattered in an inflammatory background. The nuclei were round or oval, and macronucleoli were marked. The cytologic diagnosis was malignant lymphoma. Postoperative histologic evaluation verified the presence of a primary malignant lymphoma in the uterine corpus, with a B-cell phenotype. CONCLUSION: Preoperative endometrial cytology correctly demonstrated malignant lymphoma of the uterine corpus.     

Hemophagocytic histiocytosis diagnosed by fine needle aspiration cytology of the spleen. A case report

BACKGROUND: Hemophagocytic histiocytosis (HPS) is an idiopathic, familial or secondary syndrome characterized by mature histiocytes causing intensive erythrophagocytosis. CASE: A 2-month-old male suffering from autoimmune hemolytic anemia, fever, jaundice and hepatosplenomegalia underwent fine needle aspiration cytology of the spleen. Aspiration was performed using a 23-gauge, short needle with a subcostal approach. The smear showed a monomorphous cell population of mature histiocytes with marginal nuclei and wide, well-defined cytoplasm. The cytoplasm was microvaculated and often contained > or = 1 erythrocytes and occasional lymphocytes. Immunostaining performed on cytospin samples showed diffuse positivity for alpha-1-antichymotrypsin and S-100. Differential diagnosis with malignant histiocytosis, Langerhans histiocytosis and sinus histiocytosis with massive lymphadenopathy was established. HPS was diagnosed because of the cytologic and immunocytochemical features and clinical data. CONCLUSION: HPS may be diagnosed using fine needle aspiration of the spleen when other biopsy samples have been unsuccessful. Cytologic, diagnosis of HPS should always be considered in a specific clinical setting, because early treatment can often save the patient's life.     

Langerhans cell histiocytosis of the thyroid diagnosed by fine needle aspiration cytology. A case report

BACKGROUND: Langerhans cell histiocytosis rarely involves the thyroid gland even in patients with multifocal disease. Unifocal disease apparently confined to the thyroid is even more rare. CASE: A 30-year-old woman presented with a 6-cm mass in the right and a 3-cm mass in the left lobe of the thyroid. Fine needle aspiration cytology showed isolated, loose aggregates and histiocytelike cells with grooved or contorted nuclei mixed in varying proportions with many mature eosinophils, scattered and small lymphocytes, multinucleated giant cells and foamy histiocytes. CONCLUSION: The cytologic features of Langerhans cell histiocytosis are characteristic. A fine needle aspiration cytology diagnosis is confirmed by histopathologic studies, imunohistochemical staining and ultrastructural studies.     

Anaplastic large cell lymphoma of the mediastinum diagnosed by transbronchial scratch cytology. A case report

BACKGROUND: Anaplastic large cell lymphoma (ALCL) is a subtype of non-Hodgkin's lymphoma characterized by CD30 antigen-positive, large neoplastic cells. We describe a case of ALCL suggested by cytologic examination of the tumor cells obtained from bronchial scratch preparations. CASE: A 26-year-old woman had had a dry cough since November 1996. Chest radiography in May 1997 revealed an abnormal shadow in the mediastinum extending to the pulmonary hilar region. The patient was hospitalized in June 1997. Computed tomography revealed a neoplastic lesion in the anterior mediastinum invading the right lung. Transbronchial scratch cytology revealed large, atypical lymphoid cells expressing CD30 and CD3 on immunocytochemical examination. A transcutaneous mediastinal biopsy was performed and a diagnosis of ALCL made. CONCLUSION: Differentiation from Hodgkin's disease was the most difficult point in this case. Detailed cytologic observation and CD3-positive immunocytology led to the correct diagnosis. The cell transfer technique of Sherman et al was very useful for immunocytologic staining. Thus, transbronchial scratch cytology was an especially valuable and effective procedure in this case.     

Oral metastasis of breast carcinoma diagnosed by fine needle aspiration cytology. A case report

BACKGROUND: Fine needle aspiration cytology (FNAC) is an important technique in the diagnosis of oral and maxillofacial conditions. The purpose of the present paper is to report a case of oral metastasis of breast carcinoma diagnosed by FNAC. CASE: A 45-year-old, black woman was referred for evaluation of symptomatic swelling in the left mandible. The medical history revealed that the patient had undergone extensive surgery to remove a lobular carcinoma. She had finished chemotherapy treatment about 5 months earlier. Due to the main diagnostic considerations of metastatic and inflammatory disease, FNAC was performed. The cytologic picture was consistent with a metastatic glandular neoplasm. CONCLUSION: FNAC is a safe, reliable, cost-effective and easy procedure and sometimes eliminates the need for open biopsy.     

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.     

Lymphonodular cryptococcosis diagnosed by fine needle aspiration cytology in hyper-IgM syndrome. A case report

BACKGROUND: Most cases of cryptococcosis are diagnosed when signs of meningitis have appeared. We report a case of lymphonodular cryptococcosis that was diagnosed by fine needle aspiration cytology (FNAC), excisional biopsy of a cervical lymph node and culture of aspirated material. CASE: An 11-year-old boy presented with a history of fever and enlarged bilateral cervical lymph nodes of two weeks' duration. Past medical history included immunoglobulin replacement for hyper-IgM syndrome for the previous eight years. FNAC smears from a cervical lymph node showed numerous yeasts of various sizes, ranging from 5 to 15 microns in diameter, located in the cytoplasm of multinucleated giant cells and in the background. In air-dried, Diff-Quik-stained slides, the yeasts stained blue and were surrounded by clear halos. Aspirated material collected in the syringe was cultured, and Cryptococcus neoformans was isolated. CONCLUSION: This case report suggests that a combination of FNAC and culture is a simple and useful method of diagnosing fungal infections. Early diagnosis by FNAC makes possible the early initiation of treatment.     

Dermal analogue tumor of the salivary gland diagnosed by fine needle aspiration cytology. A case report

BACKGROUND: Dermal analogue tumor of the salivary gland is a rare form of salivary gland adenoma. Cytologic and histologic findings of 1 case are presented. CASE: A 74-year-old-female had a dermal analogue tumor in the parotid gland diagnosed by fine needle aspiration cytology (FNAC). Aspiration smears were characterized by aggregates of uniform epithelial cells, and cell groups bordered on thick, basement membrane-like material. The tumor was excised, and the histologic sections confirmed the cytologic diagnosis. CONCLUSION: Dermal analogue tumor of the salivary gland has a distinctive cytomorphologic appearance, and diagnosis of this neoplasm by FNAC is possible. Preoperative FNAC of salivary gland lesions is important in planning the most appropriate type of treatment.     

Asymptomatic pulmonary cryptococcosis diagnosed on fine needle aspiration cytology. A case report

BACKGROUND: Cryptococcosis can be a life-threatening mycosis in immunocompromised patients. However, it has a somewhat better prognosis in immunocompetent hosts. AIDS has led to an increase in the incidence of the disease. Clinically, the lesions can be confused easily with malignancy. CASE: A 25-year-old, asymptomatic male presented for a routine health check-up. The chest radiograph showed a subpleural left apical area of consolidation, suspicious for either a neoplasm or infection. Fine needle aspiration cytology (FNAC) revealed a granulomatous lesion with refractile yeast forms of Cryptococcus, both within the multinucleate giant cells and extracellularly. This was subsequently confirmed by culture and histology. CONCLUSION: The cytomorphology of cryptococcosis is characteristic, and FNAC is a useful modality for diagnosing the infection in asymptomatic patients but needs a high index of suspicion, especially in nonimmunocompromised patients.     

Esophageal rhabdomyosarcoma: report of a case diagnosed by imprint cytology

BACKGROUND: Primary esophageal rhabdomyosarcoma (PER) is a very rare neoplasm with only 15 cases reported in the literature. Of those, only 1 case underwent a preoperative cytologic evaluation. We report a case of PER with diagnosis by imprint cytology. CASE: A 55-year-old woman presented with dysphagia of 2 months' duration associated with fatigue and weight loss. Clinical and diagnostic imaging investigations revealed a large, submucosal mass lesion located in the lower part of the esophagus. A bite biopsy of the esophageal mass was performed under esophagoscopy. Two imprint smears were made from the biopsied tissue fragment and stained with the May-Grünwald-Giemsa method. The smears revealed abundant, pleomorphic, malignant cells with basophilic cytoplasm. Some spindle-shaped cancer cells showed intracytoplasmic cross-striations, indicating a pleomorphic rhabdomyosarcoma, as confirmed by histologic and immunohistochemical studies of the biopsied tumor tissue and resected tumor. CONCLUSION: The presence of pleomorphic malignant cells with intracytoplasmic cross striations is a characteristic feature of pleomorphic rhabdomyosarcoma.