Asunto(s)
Biopsia con Aguja Fina , Endosonografía , Eosinofilia/patología , Esofagitis/patología , Ganglios Linfáticos/patología , Adulto , Trastornos de Deglución/etiología , Diagnóstico Diferencial , Eosinofilia/diagnóstico por imagen , Esofagitis/diagnóstico por imagen , Esófago/diagnóstico por imagen , Esófago/patología , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Masculino , MediastinoAsunto(s)
Biopsia con Aguja Fina/métodos , Endosonografía , Linfadenitis/diagnóstico , Linfadenitis/microbiología , Enfermedades del Mediastino/diagnóstico , Enfermedades del Mediastino/microbiología , Mediastinoscopía , Adulto , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium kansasii , Nocardiosis/diagnóstico , Tuberculosis Ganglionar/diagnósticoRESUMEN
Serous cystadenoma of the pancreas is an uncommon neoplasm that occasionally exhibits papillary differentiation. The cytomorphologic structure of pancreatic serous cystadenoma has been rarely described, and, to our knowledge, such papillary morphologic structure has never been reported on fine-needle aspiration cytologic examination. We present a case of serous cystadenoma of the pancreas in a 77-year-old woman. Endoscopic ultrasonography showed a well-demarcated solid/cystic mass in the midbody of the pancreas, suggestive of solid pseudopapillary tumor. Aspiration cytologic examination, performed under endoscopic ultrasound guidance, showed a predominantly papillary epithelial neoplasm consistent with the radiologic impression. Gross and histologic examination of the excised specimen revealed a pancreatic serous cystadenoma with multifocal papillae. This case illustrates the cytomorphologic structure of serous cystadenoma that presents with prominent papillary differentiation on aspiration cytologic examination. The unusual cytologic appearance of this tumor introduces significant diagnostic challenges to the pathologist. Serous cystadenoma must be included in the differential diagnosis of pancreatic neoplasms with papillary morphologic structure as evaluated by fine-needle aspiration cytologic examination.
Asunto(s)
Cistoadenoma Papilar/patología , Cistadenoma Seroso/patología , Neoplasias Pancreáticas/patología , Anciano , Biomarcadores de Tumor/análisis , Biopsia con Aguja , Cistoadenoma Papilar/química , Cistoadenoma Papilar/diagnóstico por imagen , Cistoadenoma Papilar/cirugía , Cistadenoma Seroso/química , Cistadenoma Seroso/diagnóstico por imagen , Cistadenoma Seroso/cirugía , Endosonografía , Femenino , Humanos , Inmunohistoquímica , Neoplasias Pancreáticas/química , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugíaRESUMEN
Malignant peripheral nerve sheath tumor (MPNST) is an uncommon mesenchymal neoplasm of neural origin. MPNST arising in the uterus is extremely rare. Its histologic appearance on this anatomical location has been only rarely reported. A 62-yr-old woman with a previous history of partial hysterectomy presented with a large pelvic mass in the uterine stump. Fine-needle aspiration (FNA) and core biopsy were obtained under ultrasonographic guidance, and the diagnosis of MPNST was established. The cytologic and histologic findings were consistent with a spindle-cell neoplasm suggestive of MPNST. The tumor cells were focally positive for S-100 protein immunostain, thus providing further support for the neoplasm's nerve sheath differentiation. The patient had no history of von Recklinghausen's disease. Resection of the mass confirmed the diagnosis of MPNST. To our knowledge, the FNA cytology of MPNST in this unusual location has not been previously reported. FNA cytology, along with core biopsy and immunochemistry, is a reliable tool in the diagnosis of MPNST.
Asunto(s)
Neoplasias de la Vaina del Nervio/patología , Neoplasias Uterinas/patología , Biopsia con Aguja , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Laparotomía , Persona de Mediana Edad , Neoplasias de la Vaina del Nervio/diagnóstico por imagen , Neoplasias de la Vaina del Nervio/cirugía , Ultrasonografía , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/cirugíaRESUMEN
Fibromatosis colli is a benign disorder presenting as a neck mass in neonates and older children. The differential diagnosis includes malignancies such as rhabdomyosarcoma. Neck masses in ten infants, discovered between the second and sixth week of age, were evaluated by fine-needle aspiration (FNA). The male to female ratio was 7:3. In 8 patients there was good obstetrical history. Six of the 8 patients had a difficult delivery, as indicated by breech presentation or the need for forceps. Diagnostic aspirations were performed between the second to ninth week of age. The major cytologic finding was benign spindle fibroblasts, usually arrayed in clusters. The cells possessed plump, ovoid nuclei. There were also multinucleated cells consistent with degenerating skeletal muscle fibers. Only one case demonstrated significant inflammation. FNA can provide a rapid and reliable diagnosis in fibromatosis colli. There is support for the idea that in this setting, the disorder is related to perinatal muscular trauma.
Asunto(s)
Biopsia con Aguja , Fibromatosis Agresiva/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Músculo Esquelético/patologíaRESUMEN
Gastrointestinal stromal tumors (GISTs) comprise a heterogeneous group of neoplasms of the gastrointestinal tract previously referred to as leiomyomas, leiomyosarcomas, or schwannomas. GISTs derive from the interstitial cell of Cajal and, in addition to variable expression of smooth muscle and neural markers, they characteristically express CD34 and CD117. To our knowledge, the cytologic appearance of gastric neoplasms designated as GISTs has never been reported. We illustrate the fine-needle aspiration (FNA) cytology findings of a gastric stromal tumor having spindle cells with delicate cytoplasm and prominent nuclear palisading. Consistent core biopsy and immunochemistry findings further supported the diagnosis of GIST. Pathologic evaluation of the resected tumor confirmed the cytologic diagnosis. In the appropriate clinical and radiologic setting, a confident diagnosis of GIST can be established by FNA cytology and core biopsy. The roles of immunochemical stains and other ancillary techniques in reaching the correct diagnosis are addressed.
Asunto(s)
Neoplasias Gástricas/diagnóstico , Células del Estroma/patología , Anciano , Biomarcadores de Tumor/análisis , Biopsia con Aguja , Femenino , Humanos , Inmunohistoquímica , Proteínas de Neoplasias/análisis , Neoplasias Gástricas/química , Neoplasias Gástricas/cirugía , Células del Estroma/química , Tomografía Computarizada por Rayos XRESUMEN
The fine-needle aspiration biopsy (FNAB) findings in two cases of hemangiopericytoma (HP), arising in the parotid gland and on the inner chest wall, respectively, are reported. Smear preparations in each case showed cytologic features of an undifferentiated spindle-cell neoplasm, whereas a core needle biopsy specimen of the chest wall mass showed a spindle-cell tumor with a "staghorn-like" arrangement of endothelium-lined vascular channels. Immunostains performed on this core biopsy, and on the surgical resection specimens in both cases, showed positive staining of tumor cells for vimentin and CD34, with negative staining for a variety of smooth muscle, epithelial, neural, and neuroendocrine markers. Electron microscopy performed in one case further supported the diagnosis of HP. With adequate sampling and appropriate use of ancillary studies, a diagnosis of HP can be reliably suggested on the basis of FNAB and core biopsy of a soft-tissue mass.
Asunto(s)
Hemangiopericitoma/diagnóstico , Neoplasias de la Parótida/diagnóstico , Neoplasias Torácicas/diagnóstico , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Biopsia con Aguja , Femenino , Hemangiopericitoma/química , Hemangiopericitoma/radioterapia , Hemangiopericitoma/cirugía , Humanos , Técnicas para Inmunoenzimas , Masculino , Proteínas de Neoplasias/análisis , Neoplasias de la Parótida/química , Neoplasias de la Parótida/radioterapia , Neoplasias de la Parótida/cirugía , Radioterapia Adyuvante , Neoplasias Torácicas/química , Neoplasias Torácicas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Uterine carcinosarcomas are uncommon, aggressive neoplasms usually afflicting postmenopausal women. Histologically, they are characterized by the presence of both malignant epithelial and stromal cells. The latter may be either homologous or heterologous in nature. The cytologic diagnosis of carcinosarcoma via fine-needle aspiration (FNA) was previously described for primary tumors arising in the parotid gland, breast, lung, and ovary. Although the diagnosis of uterine carcinosarcoma via cervicovaginal, endometrial, and peritoneal fluid cytology has been described, the FNA cytology diagnosis of recurrent uterine carcinosarcoma has only been rarely described. We present a case of recurrent uterine carcinosarcoma in a 59-yr-old woman, diagnosed by ultrasound-guided FNA cytology. Cytologic smears showed a biphasic neoplasm consisting of both malignant columnar epithelial and spindle cells, in a background of tumor diathesis. This case illustrates the diagnostic utility of aspiration cytology in the investigation of recurrent carcinosarcoma in clinically suspicious lesions arising postsurgery.
Asunto(s)
Biopsia con Aguja/métodos , Carcinosarcoma/patología , Recurrencia Local de Neoplasia/patología , Neoplasias Uterinas/patología , Carcinosarcoma/terapia , Femenino , Humanos , Histerectomía , Persona de Mediana Edad , Recurrencia Local de Neoplasia/terapia , Radioterapia Adyuvante , Ultrasonografía , Neoplasias Uterinas/terapiaRESUMEN
CONTEXT: Endoscopic brush cytology is a valuable technique for the diagnosis of pancreatobiliary malignancy. Despite its widespread use, the sensitivity of this method has been reported as approximately 50%. The specificity is usually higher than 95%. Few reports have systematically analyzed the reasons for this relatively low sensitivity. OBJECTIVES: To determine the rate and reasons for false-negative diagnoses in endoscopic brushing cytology of biliary and pancreatic ducts based on the results of sensitivity, specificity, accuracy, and positive and negative predictive values. DESIGN: Retrospective analysis of laboratory data and slide review of false-negative cases. SETTING: Two tertiary care state university hospitals. PATIENTS: A total of 183 pancreatobiliary brushing specimens obtained from patients undergoing endoscopic retrograde cholangiopancreatography for biliary or pancreatic duct disease for a 4- to 5-year period. INTERVENTION: Endoscopic retrograde cholangiopancreatography brushings. MAIN OUTCOME MEASURES: Determination of sensitivity, specificity, accuracy, and positive and negative predictive values. Analysis of false-negative results. RESULTS: The sensitivity, specificity, accuracy, and positive and negative predictive values, overall, were 48%, 98%, 79%, 92%, and 76%, respectively. Sampling error was a major cause of false-negative diagnoses (67%), followed by interpretive (17%) and technical errors (17%). CONCLUSIONS: Improvements in sensitivity and diagnostic accuracy for cancer of the pancreatobiliary tract can be achieved by optimizing slide preparatory techniques. Also, enhancement of the cytologist's diagnostic skills enables the identification of the morphologic features of premalignant lesions. Repeat brushings are indicated for suspicious or negative results not consistent with the clinical or radiologic findings.
Asunto(s)
Enfermedades de los Conductos Biliares/diagnóstico , Conductos Biliares Extrahepáticos/patología , Colangiopancreatografia Retrógrada Endoscópica/métodos , Enfermedades Pancreáticas/diagnóstico , Conductos Pancreáticos/patología , Constricción Patológica/patología , Reacciones Falso Negativas , Hospitales Universitarios , Humanos , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Dermatofibrosarcoma protuberans is a rare cutaneous soft tissue tumor of intermediate malignant potential with a characteristic tendency for recurrence. Metastases are unusual. This tumor usually occurs in the trunk and extremities and, infrequently, on the face and scalp. Its cytologic appearance on fine needle aspiration has only been rarely reported. It is characterized by numerous fibroblastlike cells that arrange as single cells or in clusters of spindle cells arrayed in a storiform pattern. CASE: A 42-year-old male presented with a one-year history of an enlarging left forehead mass (lateral brow) that was adjacent to an old surgical scar. Fine needle aspiration revealed a low grade spindle cell neoplasm morphologically identical to a dermatofibrosarcoma protuberans excised 15 years earlier, indicating tumor recurrence. CONCLUSION: Distinguishing dermatofibrosarcoma protuberans from other spindle cell tumors and fibrohistiocytic lesions may pose significant challenges to the pathologist. However, in the appropriate clinical setting and applying strict diagnostic criteria, fine needle aspiration cytology is a reliable tool in establishing the diagnosis of this neoplasm.
Asunto(s)
Biopsia con Aguja , Dermatofibrosarcoma/patología , Recurrencia Local de Neoplasia/patología , Neoplasias de los Tejidos Blandos/patología , Adulto , Frente/patología , Humanos , MasculinoRESUMEN
Inmates are generally considered a high-risk population for gynecologic neoplasia and sexually transmitted diseases. Cervical smears from prisoners of the Texas Department of Corrections (TDC) were expected initially to have higher rates of cellular abnormalities and infectious agents than do smears from the general population. The cytologic findings from 25,522 TDC gynecologic smears were compared with those of 6883 cases from The University of Texas Medical Branch (UTMB) affiliated physician private clinics, and with 56,178 from the UTMB hospital clinics. The period of study was from September 1995 to February 1998. This study revealed a 5.23% higher rate of abnormalities for TDC gynecologic smears as compared with that for the private clinic smears. However, the TDC rate of abnormalities was unexpectedly 1.08% lower than that for the UTMB clinic smears. These unexpected findings were probably the result of a more selected high-risk population referred to the UTMB clinics. The TDC smears showed also the highest incidence of trichomoniasis.
Asunto(s)
Neoplasias de los Genitales Femeninos/epidemiología , Prisiones/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Frotis Vaginal/estadística & datos numéricos , Instituciones de Atención Ambulatoria , Femenino , Neoplasias de los Genitales Femeninos/patología , Encuestas Epidemiológicas , Humanos , Incidencia , Medición de Riesgo , Enfermedades de Transmisión Sexual/microbiología , Texas/epidemiologíaRESUMEN
Primary pulmonary sarcomas are uncommon neoplasms. Primary fibrosarcoma of the lung is extremely rare, and only 53 cases have been documented in the literature to date. To our knowledge, the diagnosis of primary lung fibrosarcoma by fine-needle aspiration cytology has never been reported. We report a case of pulmonary fibrosarcoma diagnosed by fine-needle aspiration cytology and core biopsy. The neoplasm consisted of interweaving fascicles of minimally atypical spindle cells with slender nuclei and scant cytoplasm. Positive immunohistochemistry for vimentin along with nonreactivity of tumor cells for keratin, S100 protein, desmin, alpha-smooth muscle actin, and CD34 supported the the diagnosis. The diagnosis was later confirmed by histologic and ultrastructural findings following lobectomy. A meticulous clinical search for a possible primary neoplasm elsewhere was unsuccessful, and lung was established as the primary site. Fine-needle aspiration cytology and core biopsy are reliable methods for establishing a diagnosis of fibrosarcoma.
Asunto(s)
Biopsia con Aguja , Biopsia , Fibrosarcoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Adulto , Fibrosarcoma/complicaciones , Fibrosarcoma/patología , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Masculino , Microscopía Electrónica , Vimentina/análisisRESUMEN
BACKGROUND: Alveolar soft part sarcoma is a rare soft tissue tumor of uncertain origin usually affecting young adults. This neoplasm has early metastatic potential. Its cytologic features, particularly when presenting with metastases, have rarely been described. CASE: A 23-year-old male presented with shortness of breath and scapular pain. Routine chest roentgenograms revealed multiple lung nodules. Malignancy was established by percutaneous fluoroscopically guided fine needle aspiration on a lung nodule. Possible metastatic alveolar soft part sarcoma was suggested by cytology among few considerations in the differential diagnosis. Alveolar soft part sarcoma was confirmed by lung core biopsy and further supported by immunohistochemistry and electron microscopy. Tumor cells expressed muscle-specific actin and myoglobin, and contained diastase-resistant inclusions with periodic acid-Schiff stain. Ultrastructurally, peculiar, elongated intracytoplasmic crystalline bodies typical of this neoplasm were identified. A meticulous clinical search led to finding the primary tumor deeply located in the right posterior thigh. CONCLUSION: Aspiration cytology is a reliable, cost-efficient technique in the diagnostic workup of masses suspicious for malignancy.
Asunto(s)
Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Sarcoma de Parte Blanda Alveolar/patología , Sarcoma de Parte Blanda Alveolar/secundario , Neoplasias de los Tejidos Blandos/patología , Muslo , Adulto , Biopsia con Aguja , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/ultraestructura , Masculino , Sarcoma de Parte Blanda Alveolar/ultraestructura , Neoplasias de los Tejidos Blandos/ultraestructuraRESUMEN
Microcystic adenoma is an uncommon neoplasm of the pancreas usually affecting older people. Its histologic features have been well characterized. The cytologic appearance of this tumor has been described only rarely, however, Microcystic adenomas may enlarge considerably and often produce symptoms related to their compression to adjacent anatomic structures. The fact that this neoplasm is almost always benign indicates the need for accurate preoperative diagnosis to differentiate it from other, more common, malignant or potentially malignant tumors of the pancreas. We present a case of pancreatic microcystic adenoma initially diagnosed by percutaneous image-guided fine-needle aspiration cytologic examination and core biopsy and further evaluated by endoscopic ultrasound-guided fine-needle aspiration on follow-up. This case report illustrates that microcystic adenoma of the pancreas can be accurately diagnosed by aspiration cytology. Fine-needle aspiration--percutaneous, guided by computerized tomography, or endoscopically guided by ultrasonography--constitutes a reliable and cost-efficient diagnostic tool associated with minimal trauma to the patient.
Asunto(s)
Adenoma/patología , Endosonografía/métodos , Neoplasias Pancreáticas/patología , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Femenino , HumanosRESUMEN
BACKGROUND: Fibrous dysplasia (FD) is a benign disorder of bone consisting of intramedullary proliferation of fibrous tissue and irregularly distributed, poorly developed bone. Although tumorlike in appearance, FD is probably a condition resulting from failure of maturation from woven to lamellar bone. The histology of FD has been well characterized since Lichtenstein first reported it, in 1938; however, the cytologic appearance has been described only rarely. To our knowledge, this is the first case report of fine needle aspiration (FNA) cytomorphology of FD. CASE: A 30-year-old female with breast carcinoma, diagnosed a month earlier, underwent computed tomography-guided FNA of a rib lesion radiologically thought to represent FD, although metastatic cancer could not be excluded. The smears contained blood, occasional osteoclastic multinucleated giant cells and frequent C-shaped fibrillary structures with dark central areas and lighter peripheries, representing woven bone. The cytologic/radiologic impression of FD was confirmed histologically. CONCLUSION: FNA cytodiagnosis of FD is possible in the setting of consistent clinical and radiologic findings.
Asunto(s)
Displasia Fibrosa Monostótica/diagnóstico , Displasia Fibrosa Monostótica/patología , Adulto , Biopsia con Aguja/métodos , Femenino , Displasia Fibrosa Monostótica/diagnóstico por imagen , Humanos , Radiografía , CostillasRESUMEN
Diagnosis in certain metabolic diseases or the establishment of long-term reservoirs of cytogenetic material requires tissue culture of fibroblasts obtained by skin snip or punch biopsy. Fine needle aspiration biopsy (FNAB) was investigated as an alternative method of fibroblast collection with advantages of minimal morbidity and the potential of better patient acceptance. After flank FNAB, culture, and incubation, confluent fibroblast growth was achieved within 19 days. The number of cells produced was sufficient for potential cytogenetic or metabolic studies. Cultured fibroblasts obtained via FNAB proved to be a successful alternative to skin biopsy, with reduced trauma and better cosmetic results.
Asunto(s)
Biopsia con Aguja/métodos , Técnicas de Cultivo de Célula/métodos , Fibroblastos/patología , Enfermedades Genéticas Congénitas/diagnóstico , Enfermedades Metabólicas/diagnóstico , Adulto , Niño , Citogenética , Enfermedades Genéticas Congénitas/genética , Enfermedades Genéticas Congénitas/patología , Humanos , Enfermedades Metabólicas/genética , Enfermedades Metabólicas/patología , Piel/patologíaRESUMEN
Fine-needle aspiration (FNA) is a diagnostic modality that continues to improve in accuracy as training and experience accumulate. With increasing operator expertise and improved localization techniques, greater numbers of patients are able to benefit from FNAs performed on sites that are otherwise difficult or dangerous to reach by conventional surgery. We present a retrospective review of a 2-yr experience with radiologically-guided deep-seated FNA. In 115 cases involving transthoracic and transabdominal sites, we achieved the following overall figures: 91.9% sensitivity, 100% specificity, 93.9% diagnostic accuracy, 100% positive predictive value, and 80.6% negative predictive value. Our results are compared to those in other series. When properly applied, FNA of deep-seated lesions through image guidance is equivalent to tissue diagnosis obtained by laparotomy or surgical procedures. The benefits of FNA with or without core biopsy vs. scalpel biopsy are readily apparent when one considers the morbidity, cost, turnaround time, and trauma to the patient.
Asunto(s)
Biopsia con Aguja , Neoplasias/patología , Fluoroscopía/métodos , Humanos , Neoplasias/diagnóstico por imagen , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomógrafos Computarizados por Rayos X , Ultrasonografía/métodosRESUMEN
A 47-yr-old man with history of metastatic low-grade rectal leiomyosarcoma presented with progressive protrusion of his left eye due to an enlarging orbital mass. The differential diagnosis included tumor metastasis or orbital infection due to an unknown infectious agent. Diagnostic fine-needle aspiration (FNA) of the orbit was performed on an urgent basis to institute proper therapy and to save the patient's eyesight. Cytomorphologic examination of the material demonstrated a spindle-cell neoplasm consistent with metastatic leiomyosarcoma. It is a rare event for leiomyosarcoma to occur in the orbit. On our review of the literature, the cytology of primary orbital leiomyosarcoma on FNA has only been reported once. To our knowledge, this is the first report of the FNA cytomorphology of metastatic leiomyosarcoma to the orbit.