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.     

Pulmonary dirofilariasis diagnosed by fine needle aspiration biopsy. A case report

A case of pulmonary dirofilariasis in a 62-year-old female was diagnosed by fine needle aspiration biopsy. A review of the literature revealed this to be the first reported case diagnosed by this method. The presence of bilateral lesions in this patient is an uncommon finding for this entity.     

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.     

Retroperitoneal ganglioneuroblastoma. Report of a case diagnosed by fine needle aspiration cytology and electron microscopy

Fine needle aspiration performed on a large retroperitoneal mass in a 12-year-old boy showed neuroblasts in different stages of maturation intermingled with ganglion cells, leading to a cytologic diagnosis of ganglioneuroblastoma. This diagnosis was supported by electron microscopic study of the aspirate, which showed features of neuroblastic differentiation, and by histologic study of the resected tumor.     

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.     

Primary retroperitoneal seminoma diagnosed by fine needle aspiration biopsy. A case report

A fine needle aspiration biopsy specimen of a retroperitoneal mass was submitted for cytologic evaluation. Malignant cells were found, and the cytologic appearance was consistent with seminoma although the clinical possibilities included lymphoma and adenocarcinoma of the pancreas. Cytologic features of the needle biopsy specimen included uniform neoplastic malignant cells with round nuclei and nucleoli and clear or pale-staining cytoplasm. The cells were found singly or in groups of two or three cells. Lymphocytes were intermingled with the neoplastic cells.     

Pancreatic metastasis of cardiac rhabdomyosarcoma diagnosed by fine needle aspiration. A case report.

BACKGROUND: Fine needle aspiration (FNA) is a valuable technique in the diagnosis of soft tissue tumors or their metastases. CASE REPORT: A rhabdomyosarcoma of the left atrium with metastasis to the pancreas was diagnosed by FNA in a 74-year-old female. The patient presented with dyspnea, weight loss and generalized weakness and was found to have a cardiac arrhythmia. Magnetic resonance imaging showed a 9-cm mass in the left atrium and anterior mediastinum. Computed tomography (CT) of the abdomen revealed a 2.8-cm nodule within the head of the pancreas. The patient underwent CT-guided percutaneous aspiration biopsy of the pancreatic mass on the first hospital day and, on the second day, transvenous FNA biopsy of the intracardiac mass. The cytologic morphology and immunocytochemistry of the aspirated material from both sites established a diagnosis of cardiac rhabdomysarcoma with metastasis to the pancreas. CONCLUSION: This is the fifth reported case of rhabdomysarcoma metastatic to the pancreas and the first in which the diagnosis was made by FNA, thereby eliminating the need for open biopsy.     

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.     

Retroperitoneal lymphangiomyomatosis diagnosed by fine needle aspiration: a case report

BACKGROUND: Lymphangiomyomatosis is a rare condition affecting women of childbearing age. It is characterized by an abnormal proliferation of smooth muscle cells around lymphatics, giving rise to blockage of the large lymphatics, including the thoracic duct, and resulting in chylothorax and/or chyloascitis. The lung is the most common site of involvement. Retroperitoneum and lymph nodes can be also involved. CASE: A 40-year-old woman presented with lower urinary tract symptoms after a history of trauma and was found to have a retroperitoneal mass. Fine needle aspiration cytologic examination of the milky fluid aspirated from the mass revealed a few cohesive, 3-dimensional clusters of medium-sized cells with scanty cytoplasm, and ovoid and hyperchromatic nuclei. The background contained numerous mature lymphocytes. Laparoscopy revealed a multicystic mass filled with milky fluid. Histologic examination confirmed the cytologic diagnosis of lymphangiomyomatosis. CONCLUSION: Fine needle aspiration of lymphangiomyomatosis can be performed if cohesive clusters and a lymphoid background are present in chylous-type fluid and provided that adequate clinical information is available.     

Calcinosis cutis in chronic renal failure diagnosed by fine needle aspiration. A case report

BACKGROUND: Deposition of calcium salts in the skin and subcutis, referred to as calcinosis cutis, is a common complication in patients with end-stage renal disease. The lesion can present as a mass and is amenable to fine needle aspiration (FNA). CASE: A 48-year-old man undergoing hemodialysis following a failed renal transplant presented with a 1.5-cm neck nodule. A diagnosis of calcinosis cutis was made following FNA, which obtained semiliquid, chalky material. CONCLUSION: In cytologic preparations, deposits of calcium salts can be both amorphous and refractile on Diff-Quik and Papanicolaou stain. However, the material may not be birefringent with these stains. Alizarin red S stain for calcium will permit demonstration of the characteristic birefringence.     

Oropharyngeal chordoma diagnosed by fine needle aspiration: a case report

BACKGROUND: Due to its rarity, chordoma may be difficult to differentiate from other neoplasms with a similiar myxoid background. We describe a case of chordoma involving the oropharynx inferiorly that was diagnosed by transoral fine needle aspiration (FNA) cytology (FNAC) and confirmed by histologic studies. This appears to be 1 of the few reported applications of FNA in the diagnosis of chordoma of the oropharynx in the English-language literature. CASE: A 50-year-old male presented with nocturnal dyspnea and rare hemoptysis for 6 months. A hypodense mass was located in the left posterior side of the oropharynx. FNAC of the mass showed classic physaliferous cells with a bubbly appearance and myxoid fibrillary background. The aspirate was reported as "myxoid tumor suggestive of chordoma," as confirmed by histopathologic investigation of the excisional biopsy. CONCLUSION: The cytologic features of chordoma are quite characteristic, especially on May-Grünwald-Giemsa (MGG)-stained slides. The cytoplasmic vacuoles of the physaliferous cells and the mucoid matrix of the tumor become conspicuous on MGG staining. When Papanicolaou staining is used as the only staining procedure, the cytoplasmic vacuoles of the physaliferous cells and mucoid matrix of chordomas may be overlooked. The differential diagnosis of myxoid tumors is of utmost importance for therapy and prognosis.     

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.     

Subcutaneous metastasis from transitional cell carcinoma of the bladder diagnosed by fine needle aspiration biopsy. A case report

BACKGROUND: Metastasis of transitional cell carcinoma (TCC) of the bladder to the skin and subcutaneous tissue is an uncommon finding. CASE: A 58-year-old man with a known case of high grade TCC of the bladder, presented with a right paraspinal mass. Clinically an abscess was suspected. Fine needle aspiration (FNA) showed many clusters and isolated malignant cells in an inflammatory background. The smears were diagnosed as positive for malignancy. CONCLUSION: It is essential to differentiate tumors metastatic to the skin and subcutaneous tissue from inflammatory lesions. FNA helped with the diagnosis in this case and prevented unnecessary biopsy.     

Nodular sarcoid myositis of skeletal muscle diagnosed by fine needle aspiration biopsy. A case report

BACKGROUND: Symptomatic striated muscle involvement in sarcoidosis is rare. Muscle biopsy is usually required for the diagnosis. Fine needle aspiration biopsy (FNAB) has been successfully used in diagnosing soft tissue lesions. To the best of our knowledge, FNAB of sarcoid myositis has not been reported. CASE: A 31-year-old, black female with a history of sarcoidosis presented with an enlarging, painful, left calf mass. Infected thrombi were suspected. FNAB showed numerous loosely arranged epithelioid histiocytes, multinucleated giant cells and skeletal muscle cells. The overall cytologic picture was that of granulomatous myositis. The cytologic features coupled with the patient's history and magnetic resonance imaging findings suggested sarcoid myositis. Subsequent muscle biopsy showing noncaseating granulomata and negative stains for organisms confirmed the diagnosis of nodular sarcoid myositis. CONCLUSION: Nodular sarcoid myositis can be suggested by FNAB cytology in a patient with a past history of sarcoidosis.     

Malignant islet-cell tumor of the pancreas diagnosed by fine needle aspiration biopsy. A case report

A case of malignant islet-cell tumor of the pancreas diagnosed by preoperative percutaneous fine needle aspiration biopsy and confirmed by tissue examination is reported. The cytologic presentation of this neoplasm is described, and the differential diagnosis is discussed.     

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.     

Disseminated histoplasmosis diagnosed by fine needle aspiration biopsy of the adrenal gland. A case report

A case of disseminated histoplasmosis diagnosed by fine needle aspiration (FNA) biopsy of the adrenal gland is reported for a 60-year-old man who presented with a 40-pound weight loss and abdominal computed tomography showing bilateral adrenal enlargement. FNA biopsy of the adrenal gland revealed clusters of macrophages with abundant cytoplasm containing the yeast forms of Histoplasma capsulatum. This case emphasizes that FNA is effective in diagnosing infectious as well as neoplastic conditions of the adrenal glands.     

Cytodiagnosis of hepatic amyloidosis by fine needle aspiration cytology: a case report

BACKGROUND: Amyloid in fine needle aspirates tends to be overlooked due to its rarity. It may appear at virtually any site and can be identified by special stains. CASE: In a case of amyloidosis of the liver, where fine needle aspiration cytology was instrumental in making the primary diagnosis. Smears revealed normal hepatocytes and chronic inflammatory cells. Amorphous material (amyloid) was extensively present between compressed hepatocytic clusters. It stained pale green in Papanicolaou-stained preparations and reddish purple with Giemsa stain. This material was initially thought to be hyalinized granulomas. However, it was later confirmed to be amyloid by using Congo Red stain. CONCLUSION: Whenever amorphous material is present in smears, a high index of suspicion for amyloid needs to be maintained.