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.     

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.     

Poroid hidradenoma. Report of a case with cytologic findings on fine needle aspiration.

BACKGROUND: Fine needle aspiration cytology (FNAC) can be used for establishing a diagnosis of cutaneous lesions, especially in cases with cyst formation. Poroid hidradenoma is eccrine neoplasm with both solid and cystic components. CASE: A 77-year-old female presented with a slightly elevated nodule in the skin on her left elbow. The tumor was well demarcated, 2.7 x 2.4 cm and soft, and overlying skin was slightly reddish. FNAC revealed two types of cell: one had abundant cytoplasm in which small to large, occasionally multinucleated nuclei with small but distinct nucleoli were evident. Chromatin was finely granular, and nuclear membrane was thin and almost smooth. Another type of cell had scanty cytoplasm and a round to oval nucleus with small but prominent nucleoli. Histologic diagnosis was poroid hidradenoma. CONCLUSION: FNAC can be useful for diagnosing intradermal cystic lesions before surgical resection.     

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.     

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.     

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.     

Intraabdominal follicular dendritic cell sarcoma: report of a case with fine needle aspiration findings.

BACKGROUND: Follicular dendritic cell sarcoma is a rare tumor derived from dendritic cells of lymphoid follicles. Although it shows characteristic cytologic, histologic and immunohistochemical features, it may be misdiagnosed because of the lack of experience with this entity. There are few reports in the cytologic literature describing this entity. CASE: A left hypochondrial mass was found in an 80-year-old man who had a past history of colonic carcinoma. A computed tomography-guided fine needle aspiration biopsy was performed, and the findings were initially thought to be compatible with metastatic carcinoma. The mass was excised, and a diagnosis of follicular dendritic cell sarcoma was made. CONCLUSION: Follicular dendritic cell sarcoma is characterized by loosely cohesive or syncytial groups of dendritic cells that show oval, vesicular nuclei and ill-defined cytoplasm intimately admixed with small, mature lymphocytes. The diagnosis can be confirmed by positive immunostaining for CD21 and CD35 antigens and negative staining for cytokeratin. Unusual features in our case were the presence of prominent plasma cells and intracytoplasmic, periodic acid-Schiff stain, diastase-positive deposits, with the last not described before.     

Signet-ring cell lymphoma. Report of a case diagnosed by fine needle aspiration cytology

A case of signet-ring cell lymphoma initially diagnosed by fine needle aspiration (FNA) cytology is described. Immediate evaluation of air-dried smears showed a mixture of large and small lymphoid cells, including some signet-ring forms. Immunocytochemical studies of Cytospin preparations of the remaining aspirate yielded a diagnosis of a large-cell-type B-cell signet-ring lymphoma. Subsequent bone marrow biopsies confirmed the diagnosis of a low-grade lymphoma. The advantages of on-site evaluation in aspiration cytology are discussed.     

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.     

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.     

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.     

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.     

Secretory carcinoma of the breast. Report of a case with fine needle aspiration biopsy

A case of secretory carcinoma of the breast in a 48-year-old woman studied by fine needle aspiration (FNA) cytology is presented. The prominent intracytoplasmic vacuolization and numerous signet-ring forms and the presence of sheets of neoplastic cells with large intercellular spaces should permit its diagnosis in FNA specimens. The differential diagnosis of this rare lesion from other breast neoplasms that show similar features is discussed.     

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 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.     

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.     

Lymphoepithelioid cell lymphoma (Lennert's lymphoma). Report of a case with fine needle aspiration cytology

BACKGROUND: Lymphoepithelioid cell lymphoma (LCL) is a rare morphologic variant of peripheral T-cell lymphoma. Although their histopathologic and immunohistochemical findings are well known, the cytopathologic features have not been well documented. This report describes the fine needle aspiration cytology (FNAC) findings of a case of LCL. CASE: A 75-year-old woman presented with cervical, supraclavicular, axillary and mediastinal lymphadenopathy. FNAC of a cervical lymph node was performed. The smears contained a polymorphous infiltrate formed by abundant histiocytes disposed singly or in clusters, small and medium-sized to large atypical lymphoid cells and reactive cells, including eosinophils and plasma cells. Isolated capillary-sized vessels also were observed. Histopathologic and immunohistochemical examination confirmed the diagnosis of Lennert's lymphoma. CONCLUSION: Although histopathologic and immunohistochemical studies were required for a definitive diagnosis, the findings of FNAC in this case appeared distinctive and suggested the possibility of LCL.     

Paragonimiasis of the breast. Report of a case diagnosed by fine needle aspiration

BACKGROUND: Paragonimiasis infestation is endemic mostly to Asia, Africa and South and Central America and commonly found in the lung. It is extremely rare in soft tissue. CASE: A case of paragonimiasis occurred in a 66-year-old woman who presented with a left, painful, 2-cm-diameter breast mass and had a history of eating uncooked freshwater crabs. On mammography, an ill-defined, round, isodense mass was detected without calcification. Hemorrhagic material was aspirated by fine needle aspiration (FNA) of the breast mass, which contained many parasitic eggs. They were about 90 microns long, ovoid, yellowish brown, transparent and thick shelled, with a flattened operculum at 1 end. The breast mass was completely excised. Many collapsed eggs of Paragonimus infiltrated the lobules and fibroadipose tissue, with accompanying abscess formation. To confirm the diagnosis, serologic testing for paragonimiasis was performed; it was positive for Paragonimus antibody. CONCLUSION: Paragonimiasis very rarely presents as a breast mass and can be diagnosed by FNA.     

Clear cell carcinoma arising in a cesarean section scar. Report of a case with fine needle aspiration cytology

BACKGROUND: Clear cell carcinoma arising in a cesarean section scar is an extremely rare disease. To the best of our knowledge, there is no published report on the aspiration cytology. CASE: A 56-year-old woman presented with a mass in a cesarean section scar. Initially an abdominal desmoid was considered, but the features of fine needle aspiration (FNA) cytology suggested an adenocarcinoma. The resected tumor was histologically composed of clear cell carcinoma showing cystic, solid and papillary patterns. CONCLUSION: FNA cytology of masses arising in a surgical scar can be a useful tool in obtaining an accurate pathologic diagnosis of a malignant neoplasm.