Fine needle aspiration cytology of polymorphous adenocarcinoma of the salivary glands: A report of 11 patients and review of the literature.

BACKGROUND: Polymorphous adenocarcinoma (PAC) is a rare malignant tumor of the minor salivary glands. It has an infiltrative growth, variable architectural patterns, neurotropism and cellular monomorphism. Approximately 75% of the cases show a specific mutation in the protein kinase D1 (PRKD1) gene. Reflecting the rarity of the tumor and intraoral location, the cytologic experience is limited with few reported series. In this study we analyze our cytologic experience to determine if a preoperative diagnosis is possible. METHODS: A retrospective study of 11 patients with PAC in which a cytologic study was available. A review of the literature was also performed. RESULTS: Our study shows that PAC has relatively constant cytological features. The analysis of the cytological literature although it shows some heterogeneity, also reveals repetitive cytological findings. Smears are cellular with irregular groups some showing pseudopapillary branching morphology. Monolayered clusters and small acinar structures are also present. Most cases have small metachromatic globules embedded within the groups determining a cylindromatous pattern. Tumoral cells are small and uniform with scarce to moderate cytoplasm. Nuclei are round and oval with occasional grooves and small nucleoli. CONCLUSION: PAC has characteristic cytological features that together with its location in minor salivary gland must make us consider it preoperatively. It may resemble basal cell adenoma and epithelial-rich pleomorphic adenoma so we should be cautious in the final diagnosis. Whenever possible, the characteristic cytomorphology of PCA should make us evaluate the mutational status of PRKD1 gene since it may permit a more accurate diagnosis.

Micropapillary carcinoma of the urinary tract: a cytologic study of urine and fine-needle aspirate samples.

OBJECTIVE: Micropapillary carcinoma (MPC) is an aggressive variant of urothelial carcinoma that needs early and specific recognition. In order to determine whether this tumor variant can be recognized with cytology, we evaluated a large cytohistological series. STUDY DESIGN: It was a retrospective cytohistological correlation study including 20 patients with MPC. Only those cases in which the tumor exhibited >50% of micropapillary growth were selected. Twenty exfoliative urine specimens and four needle aspirates from lymph node metastases were reviewed. RESULTS: On histology, 14 cases were infiltrative, while 6 were exclusively superficial. Cytology was characterized by numerous small, cohesive groups and single neoplastic cells. Pseudopapillae were present in 17 cases and in 9 they were a relevant finding. Morules were present in 15 cases. Isolated microacini were seen in 14 cases. Infiltrative tumors showed more neoplastic groups. Cellular atypia was prominent in 17 cases. In 15 cases, a cytologic diagnosis of urothelial carcinoma was made. One case was diagnosed as adenocarcinoma. The remaining 4 cases were considered suspicious of malignancy. CONCLUSIONS: The peculiar morphology of MPC of the urinary tract is partially reflected on cytology, allowing in some cases a specific recognition. This is important since the aggressive behavior of this neoplasm needs rapid management and treatment.

Fine-needle aspiration cytology of large cell neuroendocrine carcinoma of the lung: a cytohistologic correlation study of 11 cases.

BACKGROUND: The classification of pulmonary neuroendocrine neoplasms is particularly controversial. Large cell neuroendocrine carcinoma (LCNEC) has emerged as a separate entity among pulmonary endocrine neoplasms and the criteria for its histologic diagnosis are now well-described. However, cytologic diagnosis presents more difficulties and to the authors' knowledge, few cytologic studies concerning the entity have been published to date. The objective of the current study was to describe the cytologic features of LCNEC in an attempt to distinguish it from other pulmonary carcinomas. METHODS: A cytohistologic study of 11 surgical lobectomy specimens classified as LCNEC was performed. In all these cases, preoperative fine-needle aspiration cytology (FNAC) material was available for review. RESULTS: The cytologic features of the cases were rather similar, resulting in a repetitive pattern. The majority of smears were hypercellular with numerous single, medium-to-large cells. Naked nuclei were abundant but a variable subset of cells demonstrated evident cytoplasm. Groups were 3-dimensional and of variable size, some of them large. Nuclear pleomorphism, molding, and mitosis were common findings. A necrotic background was evident in 6 cases. In 6 cases, neoplastic groups demonstrated peripheral nuclear palisading. Rosette-like structures were present in samples from 5 patients. In 4 cases, immunocytochemistry for the detection of synaptophysin was performed, with positive results. CONCLUSIONS: The authors' experience with 11 FNAC cases of LCNEC, has led them to believe that the cytologic image of LCNEC is peculiar and recognizable in many cases. Nevertheless, it is a difficult diagnosis to make and immunocytochemistry plays a critical diagnostic role.

Cytologic diagnostic accuracy in pleomorphic adenoma of the salivary glands during 2 periods. A comparative analysis.

OBJECTIVE: To determine if previous experience with the cytologic presentation of pleomorphic adenoma (PA) results in a lower number of diagnostic errors. STUDY DESIGN: Comparative analysis of the diagnostic accuracy of PA during 2 periods (1980-1994 and 1995-2003). The first period included 198 tumors and the second, 230. Diagnostic errors were divided into major or minor according to the consequences for patient management. Major errors were considered those that could result in an erroneous surgical approach or treatment delay. RESULTS: Concordant results increased from 88.4% to 91.2%. Sensitivity rose from 92.6% to 95.5%. The false negative rate diminished from 7.1% to 4.5%. Regarding malignancy, false negative diagnoses diminished from 5 to 3. The second period included no false positive diagnoses of malignancy, while the first had 3. A total of 42 errors were present, 6 of them were nonrepresentative cases. Thirteen of the remaining 36 (36.1%) were considered major errors, while 23 (63.9%) were classified as minor errors. Major errors diminished from 8 to 5. The most significant reduction in errors occurred in the category of PA showing cystic transformation. CONCLUSION: Cytologic diagnostic accuracy of PA is high, and major errors may diminish if special attention is paid to some pitfalls. Sampling limitations and interpretive difficulties may prevent differentiation from afew cases of carcinoma ex-PA and adenoid cystic carcinoma (ACC). A few diagnostic errors are difficult to avoid. Small tissue biopsies will not resolve these problems.

Cytologic features of pheochromocytoma and retroperitoneal paraganglioma: a morphologic and immunohistochemical study of 13 cases.

OBJECTIVE: To review the cytologic features and potential pitfalls of pheochromocytoma and retroperitoneal paraganglioma and to evaluate complications of the aspiration procedure and the diagnostic utility of immunocytochemistry. STUDY DESIGN: We reviewed 15 cytologic specimens from 12 patients with 13 tumors (1 bilateral case). Ten were adrenal (pheochromocytomas) and 3 extraadrenal paragangliomas. Eleven specimens were from fine needle aspiration (FNA) procedures that were performed in collaboration with radiologists using 23-25-gauge needles. In 3 patients the cytologic material was obtained during intraoperative diagnosis. Immunocytochemistry was performed on alcohol-fixed smears. RESULTS: Two aspirates were hypocellular, while the remainder were cellular. Cells were distributed singly or formed discohesive groups. When present, cytoplasm was abundant and ill defined. Most cells had an eccentric nucleus and plasmacytoid morphology. Nuclear pleomorphism, binucleation and multinucletaion, naked nuclei and intranuclear preudoinclusions were common findings. In 2 cases a lipid background was seen focally. Evident cytoplasmic immunoexpression of synaptophysin or chromogranin was detected in the 10 cases analyzed. One patient developed a hypertensive episode during the FNA procedure. It was controlled medically without complications. CONCLUSION: When adequate cytologic material is present, the recognition of pheochromocytoma and extraadrenal paraganglioma is possible. Together with morphology, immunocytochemical studies allow a specific preoperative diagnosis. Scarce material can be a source of diagnostic errors. FNA of pheochromocytomas is not necessarily contraindicated. When analytic data are not diagnostic, FNA may follow. Aspiration must be performed in an area equipped with the therapeutic tools necessary to control a pheochromocytoma crisis.

Fine needle aspiration cytology of dedifferentiated acinic cell carcinoma of the parotid gland: a case report.

BACKGROUND: Dedifferentiation of acinic cell carcinoma (ACC) to undifferentiated carcinoma occurs rarely and entails a poor prognosis. Most cases of dedifferentiation occur as recurrences of a previously excised ACC. More rarely the neoplasm presents with areas of well-differentiated ACC coexisting with dedifferentiated ones. CASE: An 85-year-old man presented with 2 nodular areas in the right parotid area. Fine needle aspiration of both nodules was performed. In both cases cytology revealed a double epithelial component in similar proportions. The first one corresponded to cohesive groups of small to intermediate-sized, polygonal cells with round, monomorphic nuclei. They were distributed in small and larger, branching groups with acinic morphology. Intermixed with this population, irregular groups of larger, pleomorphic cells with irregular nuclei, prominent nucleoli and scarce cytoplasm were present. In addition, smears showed an abundant lymphoid background. A cytologic diagnosis of "salivary carcinoma with coexisting areas of acinic cell differentiation and high grade, undifferentiated carcinoma" was given. Histopathology revealed a well-differentiated ACC with areas of high grade undifferentiated carcinoma (dedifferentiated ACC). CONCLUSION: The current case expands the cytomorphologic spectrum of ACC. Cytology may permit the preoperative recognition of dedifferentiation, allowing a more sound therapeutic approach.

Fine needle aspiration of toxoplasmic (Piringer-Kuchinka) lymphadenitis: a cytohistologic correlation study.

OBJECTIVE: To define the cytomorphologic features of toxoplasmic lymphadenitis (TL) and to establish the diagnostic sensitivity and specificity of the cytologic diagnosis. STUDY DESIGN: A cytohistologic correlation study of 11 patients in which a histologic diagnosis of TL was available. These cases were analyzed in a blind study among other cases of nonneoplastic lymphadenopathies. The results of the study are expressed in terms of diagnostic sensitivity and specificity. Although not included in the study, 3 other cases of TL with serologic confirmation were also reviewed. RESULTS: Microgranulomas were a characteristic finding in TL. They consisted of small clusters of epithelioid histiocytes, each with abundant cytoplasm and an eccentric, oval nucleus. Diff-Quik-stained smears had cytoplasm with particularly pale staining and a homogeneous appearance. Most microgranulomas had a monotonous appearance with a few, small lymphocytes accompanying the epithelioid cells. No necrosis, suppurative changes or giant cells were present. Blind examination by 4 reviewers led to a correct diagnosis of TL in 9 of the 11 cases. Eight of the 9 cases were recognized by each of the 4 reviewers. One false positive diagnosis was made by 1 of the reviewers. The sensitivity of the diagnosis was 72.7-81.8% and the specificity 98.8-100%. CONCLUSION: This study showed high sensitivity and specificity for the cytologic diagnosis of TL. Given the appropriate clinical context, the presence of characteristic epithelioid microgranulomas permits a diagnosis of TL. The cytologic diagnosis can be easily confirmed with serologic studies, thereby avoiding biopsy.

Fine-needle aspiration cytology of metastatic nasopharyngeal carcinoma.

Cytological features of nasopharyngeal carcinoma (NPC) were reviewed in an attempt to select cytological criteria that permit a specific recognition of metastases. For this purpose, 54 fine-needle aspiration (FNA) procedures from 43 patients with NPC were analyzed. Thirty-two (59.3%) procedures were performed before the histological diagnosis. In 25 (46.3%) procedures, smears showed many neoplastic single cells, clusters, and abundant lymphoid cells (mixed pattern). A dissociated (single cell) pattern consisting of individual neoplastic and lymphoid cells was seen in 18 (33.3%) cases. Finally, 11 (20.4%) cases showed cohesive epithelial clusters (cohesive pattern) without relevant cellular dissociation or lymphoid cells. Squamous-cell differentiation was seen in three of these cases. Most single neoplastic cells presented as large, pleomorphic naked nuclei. Other interesting findings were granulomas (n = 3), prominent eosinophilic infiltrates (n = 4), and suppurative changes (n = 5). In most smears with mixed and dissociated patterns, a nasopharyngeal origin could be suggested. On the contrary, those smears with a cohesive pattern were indistinguishable from other head and neck carcinomas. The presence (on cervical lymph nodes) of a dissociated or mixed (single cells and groups) architectural pattern of large, anaplastic cells and naked nuclei accompanied by an abundant lymphoid component is highly suggestive of undifferentiated NPC. Cytology offers a rapid diagnosis, establishes the necessity of a complete cavum examination, and helps in avoiding unnecessary and harmful biopsies.

Fine-needle aspiration cytology of lipoblastoma: a report of two cases.

Lipoblastoma is an uncommon lipomatous tumor that typically occurs in infants and children. It may present as a single subcutaneous nodule or with multiple lesions (lipoblastomatosis). We describe fine-needle aspiration (FNA) cytologic features of two cases that presented as a subcutaneous lump in the scapular area and as a deeply located mass in the left arm. Smears showed fragments of adipose tissue that consisted of numerous vacuolated adipocytes with few stroma. Nuclei were small and located centrically, without indentations. Myxoid stromal material was a remarkable finding in one case. Both cases showed small delicate vessels, mainly in relation with the myxoid material. No necrosis, atypia, or mitotic figures were present. Cytologic features were characteristic enough to permit a specific diagnosis (adipose tumor suggestive of lipoblastoma). The differential diagnosis should consider lipoma with regressive changes, well-differentiated and mixoid liposarcoma. In addition to cytologic features, the patient's age is very useful for differentiation.

Fine needle aspiration cytology of endocrine neoplasms of the pancreas. Morphologic and immunocytochemical findings in 20 cases.

OBJECTIVE: To analyze the role of fine needle aspiration (FNA) cytology in the preoperative diagnosis of pancreatic endocrine neoplasms. METHODS: Cytologic and histologic diagnoses of pancreatic endocrine tumors were reviewed. A total of 20 FNA cytologic procedures from 20 patients were selected. A false positive case, a retroperitoneal paraganglioma, was also reviewed. Two groups of patients were established: (1) those in whom a surgical biopsy with an immunohistochemical study was available (n = 13), and (2) those with a pancreatic tumor in which the diagnosis was confirmed by immunocytochemical studies (n = 7). In 13 cases the pancreatic tumor was aspirated, while in 7, liver metastases were studied. The immunoexpression of chromogranin and synaptophysin was evaluated in alcohol-fixed smears from 12 and 11 cases, respectively. RESULTS: One false negative and 1 false positive diagnosis were present. In the remaining 19 cases a cytologic diagnosis of pancreatic endocrine tumor was given. Main cytologic features were: (1) a prominent cellular dissociation with many single cells and small, poorly cohesive groups; (2) intermediate to large size cells with ill-defined cytoplasm, naked or eccentric nuclei, and frequent binucleation; and (3) variable nuclear pleomorphism with the characteristic finely granular distribution of the chromatin. Immunocytochemical evidence of endocrine differentiation (chromogranin or synaptophysin) was present in the 12 cases analyzed. CONCLUSION: FNA cytology offers the possibility of a precise preoperative, noninvasive diagnosis of pancreatic endocrine tumors. Cytologic features differ considerably from those of pancreatic adenocarcinoma, allowing differentiation from nonfunctioning endocrine neoplasms. In difficult cases immunocytologic studies are very helpful.

Cytologic features of clear cell carcinoma of the female genital tract. Diagnostic value of the "raspberry body" in nonexfoliative cytologic specimens.

OBJECTIVE: To evaluate the presence of basement membrane stromal material in fine needle aspiration (FNA) and scrape cytologic specimens from patients with clear cell carcinoma (CCC) of the female genital tract. STUDY DESIGN: The study group consisted of 6 patients with CCC (5 ovarian and 1 cervical). Four samples corresponded to FNA specimens and 3 to scrape material obtained during intraoperative consultation for ovarian tumors. FNA was performed on a pelvic recurrence and on liver, pulmonary and lymph node metastases. The 6 cases had a complete histopathologic study. RESULTS: In addition to large, clear cells, all cases showed basement membrane stromal material that assumed several forms. The most common was globular, hyaline structures, either naked or surrounded by neoplastic epithelial cells ("raspberry bodies"). Other fragments were larger, with several spherules and elongated prolongations. Scrape material showed stromal material resembling reduplicated basement membrane material. In Diff-Quik-stained smears (QCA, Tarragana, Spain) it showed metachromatic staining with a pink to purple color. Its recognition on Papanicolaou-stained smears was more difficult since it did not stain or was gray. CONCLUSION: Basement membrane stromal material and, more precisely, "raspberry bodies," are a characteristic cytologic feature of CCC of the female genital tract. The combination of clear, atypical cells and basement membrane stroma is highly specific to this neoplasm and can be observed not only in exfoliative specimens but also in FNA and scrape samples.

Cytologic features of round cell liposarcoma: a report on five patients.

BACKGROUND: Round cell liposarcoma (RCL) and myxoid liposarcoma are now considered as a single pathologic entity for several reasons. Despite many similarities, both morphologic phenotypes may differ considerably, and RCL may be difficult to recognize as liposarcoma. In addition, few cytologic reports describing features of RCL are available. METHODS: Five patients with RCL for whom cytologic study of the tumor was available were reviewed. Only tumors in which round cell or poorly differentiated, hypercellular areas comprised > 75% of the tumor were considered RCL. RESULTS: Smears were hypercellular and consisted of single, round cells with scarce cytoplasm and naked nuclei. Some cells showed slightly oval rather than round nuclei. In three tumors, the background was vacuolated; and, in two tumors, intracytoplasmic vacuoles were present. Isolated fragments of myxoid stroma containing neoplastic cells were identified in two tumors. Pleomorphism was not a prominent finding. CONCLUSIONS: RCL may show morphologic features that are uncommon for a conventional liposarcoma, leading to an erroneous cytologic interpretation. This variant of liposarcoma must be considered when evaluating round cell neoplasms, mainly in adult patients. The presence of oval cells, vacuoles (intracytoplasmic or extracellular), and myxoid stroma should raise this diagnostic possibility, avoiding confusion with other well-known round cell neoplasms.

Fine-needle aspiration cytology of extranodal natural killer/T-cell lymphoma.

Extranodal NK/T-cell lymphoma, nasal type, is a predominantly extranodal lymphoma characterized histologically by prominent necrosis, angiocentric growth, and vascular destruction. Only one report describing its fine-needle aspiration (FNA) cytologic features is available and shows highly unusual findings for a lymphoma. The present case concerns a 58-yr-old patient that presented with a soft tissue mass of the thigh in addition to an ulcerative lesion of the palate and nodular hepatic and splenic lesions. FNA cytology of the thigh tumor was interpreted as a malignant mesenchymal lesion (sarcoma). The subsequent pathologic study revealed an NK/T-cell lymphoma. Our findings are very similar to those previously reported. They were highly unusual for a lymphoma and consisted of polymorphic, round to spindle neoplastic cells distributed in irregular aggregates, and single cells. No significant number of lymphoglandular bodies were present.

Cytologic features of alveolar soft part sarcoma: report of three cases.

Alveolar soft part sarcoma (ASPS) is a rare, high-grade, epithelial-like sarcoma that shows characteristic histopathologic findings. Although a chromosomal anomaly that seems specific has been recently described, its diagnosis is based on histologic and ultrastructural features. The tumor shows no specific immunohistologic findings. Cytologic features of three cases of ASPS are presented. Preoperative fine-needle aspiration (FNA) of the primary soft tissue tumor was performed in two cases. In another two, mediastinal and pulmonary and subcutaneous metastatic lesions were aspirated. In all cases the cytologic image was identical with numerous, dissociated, large neoplastic cells with round-to-plasmocytoid morphology. Cytoplasmic fragility and granularity with abundant, atypical, naked nuclei were present. In one case, FNA material was available for ultrastructural studies. It disclosed the characteristic cytoplasmic crystalline structures. A specific cytologic diagnosis of ASPS was given in all cases. In conclusion, ASPS is a rare neoplastic entity that shows a characteristic cytologic image. When accompanied by an adequate clinical context it permits specific preoperative recognition. While immunocytologic studies are helpful to exclude other neoplasms, ultrastructure may result in an exact diagnosis.