Cytopathology of oncocytic carcinoid tumor of the lung mimicking granular cell tumor. A case report

BACKGROUND: The cytopathologic features of oncocytic carcinoid tumor of the lung, a rare variant of carcinoid tumor that is composed exclusively of oncocytes, have not been described before in detail. CASE: The bronchial brush smears from an 80-year-old female with an endobronchial obstructive tumor showed single and loose clusters of tumor cells with abundant granular, eosinophilic cytoplasm. The differential diagnoses included oncocytic carcinoid tumor, granular cell tumor, other oncocytic tumors of bronchial origin and metastatic oncocytic tumors. Immunocytochemistry and electron microscopy confirmed the diagnosis of oncocytic carcinoid tumor. CONCLUSION: Oncocytic carcinoid tumor of the lung has cytopathologic features similar to those of granular cell tumor and pulmonary oncocytoma. Immunocytochemistry, electron microscope or both are necessary to distinguish these neoplasms.     

Mediastinal pleomorphic liposarcoma diagnosed by fine needle aspiration biopsy: a case report

BACKGROUND: Progress in radiology and pathology for diagnosing mediastinal tumors has R been made in recent decades, thanks to the use of fine needle aspiration biopsy (FNAB) guided by computed tomography, which has replaced mediastinoscopy and open biopsies. CASE: A 66-year-old male had a history o productive coughing with mucopurulent expectoration, progressive dyspnea, arthralgias, myalgias, astenia and adynamia for the previous 3 months. A CT scan and magnetic resonance imaging revealed a poorly limited tumor mass ofheterogeneous den sity in the anterior mediastinum. FNAB of the tumor mass showed malignant cells compatible with liposarcoma. CONCLUSLON: Of the several types of mesenchymal mediastinal neoplasms, liposarcoma is the most important. Many of them are seen in adults, and <10 cases have been diagnosed in children. The symptoms are related to compression of the nearby airways. Usually liposarcomas are yellow, lobed tumors without capsules that infiltrate adjacent organs and tissues. Microscopically, they have the same histologic spectrum as tumors originating in other sites. Thus, it is common to observe all the histologic varieties of soft tissue liposarcomas. The identification of lipoblasts is the key to the correct diagnosis in FNAB material.     

Bronchial granular-cell tumor. Report of a case with preoperative cytologic diagnosis on bronchial brushings and immunohistochemical studies

A 42-year-old man presented with a polypoid endobronchial mass of the right apical segmental bronchus. Bronchial brushing smears contained clusters of cells exhibiting abundant diffusely granular cytoplasm with indistinct borders. A cytologic diagnosis of granular-cell tumor was rendered. Histologic examination of the upper right lobectomy specimen provided confirmation. Immunohistochemically, the granular cells strongly reacted with the S-100 protein antibody. This case demonstrates that the cytologic diagnosis of bronchial granular-cell tumor is possible if this lesion is considered in the differential diagnosis of lung tumors.     

Diagnosis of thymolipoma with fine needle aspiration biopsy. Report of a case initially misdiagnosed as liposarcoma

BACKGROUND: Thymolipomas are the most outstanding mesenchymal mediastinal tumors although they represent only a small percentage of thymic neoplasms. Their histogenesis remains unsolved, and they are usually benign. Fine needle aspiration biopsy (FNAB) has become the method of choice for the study of mediastinal tumors, including thymolipomas. Making the correct diagnosis depends on the availability of all thymic and lipomatous components as well as on the correct application of a differential diagnosis with other lipomatous tumors. CASE: A 24-year-old woman had a 3-month history of coughing with sputum, fever, asthenia, adynamia, headaches and anemia. Physical examination revealed a bilateral pulmonary condensation syndrome. Imaging studies showed a well-defined, large mass occupying both hemithoraxes and the mediastinum. FNAB revealed an admixture of atypical adipocytes, nonneoplasic lymphoid tissue and capillaries with prominent endothelium. An initial diagnosis of well-differentiated liposarcoma was made. A 2.8-kg, encapsulated, yellowish gray mediastinal tumor was surgically removed. Mature adipose tissue intermingled with abundant thymic tissue containing numerous Hassall's corpuscles were seen histologically. Immunohistochemical markers for thymic epithelium, lymphoid tissue and adipocytes were all positive. Thymolipoma was the final diagnosis. The anemia subsided with resection of the tumor, and the patient was disease free 2.5 years after surgery. CONCLUSION: To the best of our knowledge, this is the second report of a thymolipoma studied with FNAB. The criteria for the differential diagnosis between thymolipomas and other lipomatous tumours should be kept in mind.     

Fine needle aspiration cytology diagnosis of a cutaneous granular cell tumor in a 7-year-old child. A case report

BACKGROUND: Granular cell tumors are neoplasms of uncertain histogenesis, although a neural origin is favored. Most reports on the cytologic features of granular cell tumors have been on lesions from the breast or respiratory tract. However, there are only a few reports on fine needle aspiration (FNA) cytologic diagnosis of cutaneous or soft tissue granular cell tumors. CASE: A 7-year-old girl presented with a skin lesion on her right forearm of one year's duration. The FNA smears showed sheets and clusters of oval to polygonal cells with an abundant amount of granular cytoplasm. Many single, scattered cells with similar morphology were seen in the background. Immunostaining for S-100 protein showed granular cytoplasmic positivity. The tumor was diagnosed as a benign granular cell tumor. The histopathology report on the excised lesion confirmed the FNA diagnosis. CONCLUSION: The cytopathologic features of granular cell tumors presenting as skin lesions are distinctive enough to allow a correct diagnosis on FNA cytology.     

Respiratory cytology in malignant lung disease – The thoracic oncologist’s perspective

Respiratory cytology continues to play a central role in the diagnosis and staging of thoracic malignancy, although over time indications have changed. Historically, sputum cytology and endobronchial brushings and washings figured prominently, but with the advent of endobronchial and endoscopic ultrasound much greater emphasis is placed on fine needle aspirates from lymph nodes. The advent of targeted sequencing panels for genomic profiling to identify driver mutations and PD-L1 directed immunotherapy means that there is a need to extract increasing amounts of diagnostic and predictive information from ever smaller amounts of diagnostic material. Recent work has demonstrated that cytology samples are well suited to delivering the information required, but in order to understand the limitations of clinical and laboratory techniques, a close working relationship between pathologist and thoracic oncologist is needed to optimise sample procurement and utilisation.     

Focus: Rare Disease: Sinonasal Glomangiopericytoma: Review of Imaging Appearance and Clinical Management Update for a Rare Sinonasal Neoplasm

Introduction: Glomangiopericytoma (GPC) is a rare tumor in the nasal cavity or paranasal sinuses with low malignant potential. Initially deemed a hemangiopericytoma, in 2005 it was classified as a distinct entity by the World Health Organization (WHO). Case Presentation: A male patient in his early 60s presented with new-onset right arm and leg weakness/numbness, who was incidentally found to have a left ethmoid sinus mass with extension in the olfactory fossa. On CT and MRI, the mass enhanced with well-defined borders and eroded the bone, but without dural enhancement. The mass was surgically excised, and pathology confirmed the diagnosis of glomangiopericytoma by microscopic appearance and staining. Discussion: Glomangiopericytoma has less than 0.5% incidence of all neoplasms of the sinonasal cavity, making it rare. Most diagnosed patients are in their 6th or 7th decade of age, with a slight female predominance. Treatment is complete surgical excision, with excellent prognosis, although there is up to 17% local recurrence. Despite the non-specific appearance on CT and MRI, imaging can help provide differential diagnosis, tumor extent, size, and reassuring non-aggressive characteristics of the tumor prior to surgery. GPC tumors are relatively resistant to radiation and chemotherapy. Conclusion: It is important to recognize glomangiopericytoma in the differential of masses of the nasal cavities or paranasal sinuses, as they rarely warrant aggressive treatment beyond local excision. Each reported case of glomangiopericytoma helps to build guidance for imaging and treatment since GPC is rare and not well-represented in the medical literature.     

Incidencia de cáncer de tiroides en la provincia de Neuquén,período 2001-2012

During the past decades, an increasing incidence of thyroid cancer (TC) has been reported worldwide. In Argentina there is no national cancer registry, and its incidence has therefore not been established. The aim of our study was to determine the incidence of TC in the province of Neuquén and to compare it to that reported in the literature. The medical records of 229 patients admitted over a period of 12 years (2001 to 2012) were used for data analysis.Tumor size, age, sex, and histological type were evaluated. The study period was divided into four three-year periods, and differences in each of these features were analyzed. We found an incidence of 4.72/100,000 inhabitants/year, and almost all patients had papillary TC. TC was five times more common in females as compared to males (7.78 and 1.55 respectively). Mean tumor size was 22.2 ± 1.1 mm. Tumor size was significantly greater in men (31.8 ± 3.7 mm) than in women (20.4 ± 1.0 mm). When grouped by three-year periods, a higher number of cases was found in the last one (47, 49, 49 and 84 respectively). As regards tumor distribution by size, there was a significant decrease in mean tumor size in the fourth period and an increase in the proportion of tumors <10 mm.We report an increase in TC incidence in the Argentinean province of Neuquén which is similar to the overall increase reported in the international literature.     

Interwoven dendritic processes of follicular dendritic cell sarcoma demonstrated on ultrafast papanicolaou-stained smears: a case report

BACKGROUND: Follicular dendritic cell (FDC) tumor is a rare tumor derived from accessory cells in the lymphoid follicles. FDC tumors are typically diagnosed on histology based on immunoreactivity to at least 1 of the FDC markers (CD21, CD23 or CD35) or based on the characteristic ultrastructural feature of long, interwoven, cytoplasmic, dendritic processes connected by desmosomes. CASE: We observed novel cytologic features of FDC sarcoma in a liver fine needle aspirate of a 46-year-old man status post surgery and chemotherapy for FDC sarcoma, originating in the gastrointestinal tract with metastases to the liver, pancreas and spleen. In the Diff-Quik- and Papanicolaou-stained smears, the tumor cells presented in syncytial fragments as well as single cells, as previously reported in the cytologic literature. However, the single cells were interconnected to neighboring single cells via long, thin, threadlike cytoplasmic processes in ultrafast Papanicolaou (UFP)-stained smears. The tumor cells possessed multipolar cytoplasmic processes rather than unipolar ones, as previously reported. CONCLUSION: The ultrastructural features of a web of interwoven, dendritic, cytoplasmic processes of FDC tumor was demonstrated for the first time on cytology. Observation of this feature may allow the diagnosis to be made on cytology prior to histology, immunohistochemistry or electron microscopy.     

Chest wall mesenchymal hamartoma: a case report

Chest wall mesenchymal hamartoma is an extremely rare benign tumor. Approximately 80 cases have been reported in the literature. Most tumors are manifested at birth with a painless palpable mass of the chest wall, usually unilateral. Respiratory symptoms result from extrinsic compression of the pulmonary parenchyma, and the severity of the symptoms will depend on the size and location of the lesion. Imaging features are characteristic, but definitive diagnosis is histological. Herein, a case is described of a four month old infant with diagnosis of chest wall mesenchymal hamartoma, manifested at birth. Different treatment options are described, including expectations from tumor management, the possibility of spontaneous regression, and the morbidity associated with the surgical option.     

The value of provoked expectoration in obtaining sputum samples for cytologic investigation. A prospective, consecutive and controlled investigation of 134 patients

A prospective controlled investigation in 134 consecutive outpatients compared the cytologic adequacy of sputum samples obtained by spontaneous and provoked expectoration. Inhalation of nebulized 10% sodium chloride was used for provoked expectoration. A significantly higher number of adequate samples was produced after provocation, as judged by the presence of alveolar macrophages (X2 = 5.63; p less than 0.02). The improvement in sample adequacy was limited to the nonsmokers and ex-smokers in the study. This result, together with the relatively high cost of cytologic sputum examinations, indicates that provoked expectoration should at least be applied to the collection of sputum samples from nonsmokers and ex-smokers.     

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.     

腹壁肿瘤及瘤样病变的CT 诊断（附44 例报道）

目的:分析腹壁肿瘤及瘤样病变的CT表现,旨在提高医师对腹壁肿瘤及瘤样病变的认识,并评价CT在腹壁肿瘤诊断及鉴别诊断中的价值。方法:回顾性分析44例经病理证实的腹壁肿瘤及肿瘤样病变的CT表现,并与病理结果对照。结果:(1)CT扫描对腹壁肿瘤及瘤样病变的定位诊断率达到100%(44/44),定性诊断率约84.1%(37/44)。(2)良恶性病变在边界清晰与否、大小等方面并没有差异,边界不清的29例病例中,14例为良性,15例为恶性。(3)腹壁病变呈较高密度影者均为良性(7/7),血管源性多见。(4)血管瘤、纤维肉瘤、韧带样纤维瘤亦为渐进性强化,腹壁脓肿、结核为环状强化,转移瘤为不均匀强化。结论:CT是目前诊断腹壁肿瘤及肿瘤样病变的主要手段,能较准确定位病变,但对病变定性仍有一定的困难,最终需要病理证实。     

Giant cystic metaplastic carcinoma of the breast: a case report with diagnosis by fine needle aspiration

BACKGROUND: Breast cysts are mainly benign and are reported in association with fibrocystic disease and phyllodes tumor. Rarely have cystic changes been reported to occur in malignant tumors. They are usually small but large in rare cases. Giant breast cysts are very rare, and only a few cases have been reported. CASE: A 37-year-old woman presented with a rapidly growing breast mass. Mammography showed a huge, well-circumscribed cystic mass (17 x 16 x 16 cm) suggestive of a benign lesion. Cytologic examination revealed a highly cellular tumor composed of malignant cells of various sizes and shapes in a necrotic background. The smears were diagnosed as positive for malignancy and suggested metaplastic carcinoma. Mastectomy was performed, and histologic study confirmed the cytologic diagnosis. CONCLUSION: This is the first reported case of a breast cyst of this size. Clinically the cyst was confused with a benign lesion. The fine needle aspiration aided the diagnosis and planning of treatment.     

Oncocytic carcinoid tumor of the lung: a case report of diagnostic pitfall in filter membrane preparation of bronchial washings

BACKGROUND: Oncocytic carcinoid tumor of the lung is a rare variant of pulmonary carcinoid. This report describes the morphologic appearance of this rare tumor on filter membrane preparation along with potential pitfalls. CASE: A 49-year-old woman presented with cough and expectoration. On chest radiograph a mass lesion was seen in the upper zone of the right lung. Bronchial washings were sent for evaluation. On filter membrane (Millipore) preparation of bronchial washing the possibility of a non-small cell carcinoma, possibly squamous, was suggested. Right upper lobectomy was subsequently performed and a histologic diagnosis of oncocytic carcinoid given. The cytomorphologic features of this tumor on the Millipore preparation were reviewed. CONCLUSION: Differential diagnosis of oncocytic carcinoid should be kept in mind while assessing cytologic material when tumor cells show abundant granular cytoplasm and prominent nucleoli. Oncocytic carcinoid also must be differentiated from oncocytoma and granular cell tumor. Immunocytochemistry and electron microscopy are useful in confirming the diagnosis.     

Peripheral primitive neuroectodermal tumor of the vulva: report of a case with imprint cytology.

BACKGROUND: Peripheral primitive neuroectodermal tumor (PNET) of the vulva is an extremely rare disease, and, to our knowledge, only two cases have been previously reported. CASE: A 45-year-old woman presented with a mass in the right labium major. Three years after removal of the tumor, she noticed a new lesion in the same place and underwent a partial vulvectomy. The imprint cytology of the recurrent tumor showed a monomorphic appearance, composed of small round cells with scant cytoplasm against a hemorrhagic background. These tumor cells were loosely connective, but rosettelike structures were observed focally. On pathologic examination, the neoplasm was composed of small round tumor cells showing sinusoidal, diffuse or micropapillary growth. Immunohistochemically, the neoplastic cells stained positively for neuron-specific enolase, vimentin and HBA 71 and negatively for cytokeratin, HBA 45 and muscle-specific actin. The morphologic characteristics of the disease were well expressed in the imprint cytology, and this influenced the selection of immunohistochemical studies. CONCLUSION: Cytologic examination for vulvar tumors, even imprint cytology, can be a useful tool in obtaining an accurate pathologic diagnosis of a rare disease, such as peripheral PNET.     

肾嗜酸性细胞瘤的诊治体会（附11例报告）

目的：探讨肾嗜酸细胞瘤的诊断和治疗。方法：回顾分析我院2003．2009年间收治11例肾嗜酸细胞瘤的临床资料,结合文献对肾嗜酸细胞瘤的诊断及治疗进行复习讨论。结果：本组11例患者中,年龄为26—75岁,男性7例,女性4例。合并透明细胞癌者1例,术前误诊为肾上腺肿瘤者1例。7例行根治性肾切除术者,4例行肾部分切除术。术后随访11个月-7年未见肿瘤转移或复发。结论：肾嗜酸细胞瘤倾向于良性肾实质性肿瘤,临床表现无特异性,确诊需临床表现、影像学检查与病理学检查相结合。治疗首选保肾手术,但应注意并发恶性肿瘤的可能,加强随访。     

Cytopathologic and genetic diagnosis of pulmonary amebiasis: a case report

BACKGROUND: Amebiasis is a parasitic infection with Entamoeba histolytica. Pulmonary amebiasis is rare since the infection is commonly manifested as amebic colitis or liver abscess. Most pleuropulmonary amebiasis is seen in patients with amebic liver abscesses. A pulmonary amebic lesion without either a liver abscess or amebic colitis is extremely rare. Thus, reported cases of sputum cytologic diagnosis of a pulmonary amebic lesion from a patient without a liver abscess are also very rare. CASE: A 53-year-old man presented with a dry cough and mild fever. Chest radiography revealed an abnormal solitary mass lesion in the right upper lung field. The clinical diagnosis was a bacterial lung abscess. Sputum cytologic examination demonstrated many trophozoites of E. histolytica. Following sputum cytodiagnosis, serologic tests revealed a slightly high but almost normal titer of IgG antibodies to E. histolytica, indicating the possible presence of the pathogen. Polymerase chain reaction (PCR) using E. histolytica-specific primers for DNA extracted from the sputum sample revealed specific DNA product. CONCLUSION: Pulmonary amebiasis without either a liver abscess or amebic colitis must be distinguished from bacterial abscesses and neoplastic disease. A sputum cytologic examination combined with PCR for DNA extracted from a sputum sample is a good approach to the diagnosis of a pulmonary amebic abscess.     

Cytologic diagnosis of laryngeal and hypopharyngeal squamous cell carcinoma in sputum

A prospective study of the value of sputum cytology in the diagnosis of squamous cell carcinoma of the larynx and hypopharynx is reported. Sputum cytology established the diagnosis in 63.5% of the patients with laryngeal lesions and in 77.4% of the patients with hypopharyngeal lesions. In laryngeal cancer, a positive diagnosis by sputum cytology was related to clinical T factors (according to the TNM classification): while only 29.4% of T1 lesions were positively detected by sputum cytology, 63.3% of T2 lesions, 69.7% of T3 lesions and 79.2% of T4 lesions were so detected. In hypopharyngeal cancer, there was no discernible relationship between sputum cytodiagnosis and clinical T factors. Generally, there was only a small number of cancer cells present in the sputum in these cases. Some of the squamous cancer cells were not very conspicuous and would require careful screening of the sputum specimens to be detected.