Fine needle aspiration cytology of cellular hemangioma of infancy. A case report.

BACKGROUND: Cellular hemangioma is a common benign vascular neoplasm of infants and children. The lesion typically occurs within the superficial dermis, where it is recognized as a strawberry nevus. Occasionally, this neoplasm is situated within deep soft tissues of the head or neck, with a particular predilection for the parotid gland region. Fine needle aspiration cytology (FNAC) of cellular hemangioma involving the parotid gland has been reported previously, but never confirmed by cytologic findings alone. We report the first case of infantile cellular hemangioma with sufficient characteristic cytologic features to be diagnosed by FNAC. CASE: A 3-month-old male presented with a rapidly enlarging, sensitive, solid, supraparotid mass. Ultrasound and computed tomography were performed but were nondiagnostic. Subsequent FNAC of the mass demonstrated a highly cellular specimen composed predominantly of elongated spindled cells arranged in three-dimensional coils and arcades. Immunohistochemistry demonstrated the endothelial origin of the spindled cells and confirmed the diagnosis of cellular hemangioma. CONCLUSION: Deeply situated cellular hemangiomas may pose a difficult diagnostic challenge to the clinician as well as to the radiologist. The infantile variant of this tumor enlarges rapidly, simulating an aggressive malignant tumor, and is occasionally accompanied by substantial compressive symptoms. Radiographic presentation of the lesion may be that of a solid tumor mass, unlike most other hemangiomas. Precise cytologic diagnosis of infantile cellular hemangioma can be rendered on aspirated material and is crucial in planning conservative medical treatment.

Fine needle aspiration of secretory breast carcinoma resembling lactational changes. A case report.

BACKGROUND: The cytologic features of secretory breast carcinoma were first described as recently as 1986. Only one other report of fine needle aspiration (FNA) diagnosis of secretory breast carcinoma in a male has been published, in 1994. CASE: A 33-year-old male with a unilateral breast mass present for at least 10 years underwent FNA aspiration biopsy, excisional biopsy and mastectomy. FNA cytology findings demonstrated marked overlap with features described as characteristic of lactation changes. CONCLUSION: Secretory breast carcinoma is a rare, usually well differentiated neoplasm that occurs most often in young, reproductive-age women and less often in girls and is exceedingly rare in men. The cytologic features that have been described for secretory carcinoma have emphasized the morphologic distinction from other types of breast carcinoma but have not stressed the potentially significant resemblance of this neoplasm to benign epithelial proliferative lesions, particularly lactational changes/lactating adenoma. This case illustrates features almost completely morphologically identical to the well-defined features of lactational change and emphasizes that the clinical information is ultimately important in this distinction.

Dermatofibrosarcoma protuberans of the vulva. A case report.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a cutaneous malignancy that is uncommon anywhere on the body but is especially uncommon on the vulva. This cancer rarely metastasizes but has a high incidence of local recurrence because of its tendency to grow in fingerlike projections away from the primary tumor. CASE: A 36-year-old, black woman was the 10th and youngest patient with DFSP of the vulva to be reported. Treatment of the 5-cm, mobile, well-circumscribed lesion consisted of local excision. Several adjacent microscopic lesions showing DFSP were found in the pathologic specimen, however, so an even wider excision was performed. Twenty-seven months following removal, there was no evidence of recurrence. CONCLUSION: Survival rates for DFSP of the skin range from 91% to 100% in reported series, but local recurrence rates of 20-49% have also been noted. The reported deaths from the disease have resulted from extensive local spread due to inadequate excision and, only rarely, metastases. Because DFSP tends to spread to microscopic projections away from the visible lesions, very wide local excision is required for tumor control.

Osteitis fibrosa cystica (brown tumor) of the spine with cord compression: report of a case with needle aspiration biopsy findings.

A case of osteitis fibrosa cystica or brown tumor of bone in a patient presenting with acute spinal cord compression that was suggested initially by needle aspiration biopsy of the spine is described. Following the aspiration biopsy, excision of vertebral lesions, cord decompression, and spinal fusion were successfully performed. A parathyroid adenoma was subsequently identified and also resected. Along with the diagnosis of malignancy, the presence of hyperparathyroidism with osteitis fibrosa cystica should be considered in a patient presenting with lytic lesions in bone, especially if they are associated with hypercalcemia. Serum parathormone level determination is usually diagnostic of hyperparathyroidism, but this test has a 7-10-day turnaround time. Preoperative needle aspiration biopsy is a safe and rapid method of diagnosing osteitis fibrosa cystica and may be of critical importance in a patient with acute and progressive symptoms such as cord compression.

Identification of papillary carcinoma in a thyroglossal cyst by fine-needle aspiration biopsy.

Papillary carcinoma was diagnosed in a fine-needle aspirate from a cystic upper-cervical midline lesion attached to the hyoid bone. Histological examination of the excised specimen verified the diagnosis. Carcinoma arising in thyroglossal cysts, though rare, should be considered in patients presenting with an anterior midline mass in the upper neck; fine-needle aspiration may be useful in the preoperative diagnosis.

Angiosarcoma of the breast: report of two long-term survivals.

Angiosarcoma of the breast is a rare mesenchymal malignancy with a poor prognosis. One hundred sixty-four cases have been reported in the literature with 19 five-year, and 7 ten-year disease-free survivals. Two new cases of angiosarcoma of the breast are presented here, with disease-free survivals of five and ten years. In most series reviewed, angiosarcoma of the breast demonstrates as a rapidly fatal disease. Because axillary lymph node metastasis is rare, simple mastectomy with wide surgical margins is the procedure of choice. The mammographic and histologic findings may appear deceptively benign. A correlation exists between the histologic characteristics and the prognosis. Although there have been reports of increased survival with Actinomycin D, adjuvant therapy has failed to significantly alter the course of the disease in most series.