Unexpected Tumor: Primary Asymptomatic Schwannoma in Thyroid Gland.

The discovery of a tumor as a primary schwannoma in the thyroid gland is rare (Andrion et al. in Virchows Arch 413:367-372, 1988). It represents less than 1 % of mesenchymal neoplasms of this gland. Therefore, few cases of this type are described in medical literature (Aron et al. in Cytopathology 16:206-209, 2005; Cashman et al. in Medscape J Med 10(8):201, 2008; Coleman et al. in AJR Am J Roentgenol 140:383-7, 1983). In this article, we introduce the clinical case of a 27-year-old female patient, who presented a nodular mass located in the neck region. This mass was not associated with other symptoms and during the imagistic investigation it appeared to be a thyroglossal duct cyst. A fine needle aspiration biopsy was performed which revealed benign mesenchymal cells. After a pathology study of the piece resected through a thyroidectomy, it was confirmed that the tumor had neural characteristics, the final diagnosis being a primary schwannoma. The importance of a cytology study is emphasized, since in this case, it made it possible to accurately diagnose a mesenchymal tumor, despite their low frequency. It constitutes a highly useful tool for diagnosing non-epithelial neoplasia of the thyroid gland.

[Clinical usefulness of the ImmunoCyt urinary test in the follow-up protocol of patients with urothelial neoplasms]. / Utilidad clínica del test urinario ImmunoCyt en el protocolo de revisiones de pacientes con antecedentes de neoplasia uroteliales.

OBJECTIVES: The overall objective of this study was to carry out a prospective investigation of the usefulness of the IMMUNOCYT commercial kit in the follow-up of patients treated for bladder cancer and to evaluate its utility as a complement to urinary cytology and a possible tool for reducing the number of follow-up cystoscopies required. SUBJECTS AND METHODS: From September 2001 to December 2002, the ImmunoCyt test and urinary cytology were performed in urine simples from a total of 136 patients (115 with a history or suspicion of bladder cancer and 21 patients with other urological pathologies). Urine simples were fixed with an equal volume of 50% alcohol. Urinary cytology and the ImmunoCyt test were interpreted by a cytopathologist unacquainted with the result of the corresponding cytology and bladder biopsy report. Samples were staged and graded using the 1997 TNM classification of the UICC and the 1998 WHO/ISUP classification. Histopathological confirmation of lesions was available for 111 patients (81.6%). RESULTS: The gender distribution was 89% men and 11% women. Mean age was 71.68 years (range 27 to 98 years). Overall sensitivity and specificity were 77.9% and 92.3% for the ImmunoCyt test and 47.9% and 100% for urinary cytology, respectively. The positive (PPV) and negative predictive values (NPV) were 96.4% and 61.7%, respectively, for the ImmunoCyt test and 100% and 36.7% for cytology. In Ta and low-grade carcinomas, the sensitivity of the ImmunoCyt test was 70% (n=20) and 76.4% (n=34) respectively, whereas it was 25% (n=28) and 29.7% (n=37), respectively, for urinary cytology. The differences observed between the sensitivities of the ImmunoCyt test and cytology were statistically significant (X2 p<0.05) overall and for Ta and low-grade carcinomas. The sensitivity and specificity of the combination of both tests were 86.8% and 96.2%, respectively. The sensitivity of the combination of both tests for Ta and low-grade carcinomas was 80% (n=20) and 82.3% (n=34), respectively. The ImmunoCyt test was diagnostic in 36.2% of tumors overall. CONCLUSIONS: In view of the results obtained, we decided to change our follow-up protocol to reduce the number of follow-up cystoscopies by 32.2% in the first 5 years of postoperative follow-up (in a cohort of 140 patients who undergo surgery annually). This benefits patients by reducing the number of urinary infections and iatrogenesis originated by follow-up cystoscopy. In addition, this 32.2% reduction in the number of cystoscopies in 5 years will yield a savings of approximately 35,560 EUR to the health care system in 5 years.

Utilidad clínica del test urinario ImmunocytTM en el protocolo de revisiones de pacientes con antecedentes de neoplasia uroteliales / Clinical usefulness of the InmunocytTM urinary test in the follow-up protocol of patients with urothelial neoplasms

Objectivos: El objetivo global de este trabajo es el de determinar en un estudio prospectivo la utilidad del kit comercial InmunoCyt® para el seguimiento de pacientes tratados de cáncer de vejiga y la evaluación de su utilidad como complemento de la citología urinaria y posible herramienta en la reducción del número de cistoscopias de revisión. Material y Métodos: Entre Septiembre/01 a Diciembre/02 se recogió la orina de un total de 136 pacientes (115 con antecedentes deneoplasia vesical o sospecha de la misma y 21 pacientes con otras patologías urológicas) para realizarles el test del InmunoCyt® (uCyt+) y la citología urinaria. La orina recogida era fijada con alcohol al 50% en un volumen igual. La citología urinaria y el InmunoCyt® fueron informados por un citopatólogo que desconocía tanto el resultado de su correspondiente citología como el informe de la biopsia vesical. Para el estadiaje y grado de las muestras se utilizaron la clasificación TNM de la UICC de 1997 y la de la WHO/ISUP de 1998. Se dispuso de confirmación histopatológica de las lesiones en 111 pacientes (81,6% de los pacientes). Resultados: La distribución por sexos fue del 89% para varones y del 11% mujeres. La edad media fue de 71,68 años [27-98]. La sensibilidad y especificidad globales fueron del 77,9% y 92,3% para el InmunoCyt® y del 47,9% y 100% para la citología urinaria respectivamente. Los valores predictivos positivos (VPP) y negativos (VPN) fueron del 96,4% y 61,7% respectivamente para el InmunoCyt® y del 100%y 36,7% para la citología. En los Ta y carcinomas de bajo grado la sensibilidad del InmunoCyt® fue del 70% (n=20) y 76,4% (n=34) respectivamente, mientras que para la citología urinaria fue del 25% (n=28) y 29,7% (n=37) respectivamente. Las diferencias observadas entre las sensibilidades del InmunoCyt® y de su citología fueron estadísticamente significativas (X2 p<0,05) tanto de forma global como en los Ta y en los ca. de bajo grado. La sensibilidad y especificidad conjunta de los dos test (ambos test combinados) fue del 86,8% y 96,2% respectivamente. La sensibilidad conjunta de los dos test para los Ta y bajo grado fue del 80% (n=20) y del 82,3% (n=34) respectivamente. Con el InmunoCyt® se diagnosticó de forma global un 36,2% de tumores. Conclusiones: A la vista de los resultados obtenidos decidimos cambiar nuestro protocolo de seguimiento reduciendo el número decistoscopias en las revisiones al 32,2% durante los 5 primeros años de seguimiento tras la cirugía (sobre una cohorte de 140 pacientes intervenidos anualmente). Esto supondrá un beneficio para el paciente ya que disminuirán el número de infecciones urinarias y la iatrogenia ocasionadas por la realización de las cistoscopias de seguimiento. Además, esta reducción del 32,2% del número de cistoscopias en 5 años reportará un ahorro sanitario aproximado de 35.560 € en 5 años (AU)

Objectives: The overall objective of this study was to carry out a prospective investigation of the usefulness of the IMMUNOCYT™ commercial kit in the follow-up of patients treated for bladder cancer and to evaluate its utility as a complement to urinary cytology and a possible tool for reducing the number of follow-up cystoscopies required. Subjects and methods: From September 2001 to December 2002, the ImmunoCyt™ test and urinary cytology were performed in urine simples from a total of 136 patients (115 with a history or suspicion of bladder cancer and 21 patients with other urological pathologies). Urine simples were fixed with an equal volume of 50% alcohol. Urinary cytology and the ImmunoCyt™ test were interpreted by a cytopathologist unacquainted with the result of the corresponding cytology and bladder biopsy report. Samples were staged and graded using the 1997 TNM classification of the UICC and the 1998 WHO/ISUP classification. Histopathological confirmation of lesions was available for 111 patients (81.6%). Results: The gender distribution was 89% men and 11% women. Mean age was 71.68 years (range 27 to 98 years). Overall sensitivity and specificity were 77.9% and 92.3% for the ImmunoCyt™ test and 47.9% and 100% for urinary cytology, respectively. The positive (PPV) and negative predictive values (NPV) were 96.4% and 61.7%, respectively, for the ImmunoCyt™ test and 100% and 36.7% for cytology. In Ta and low-grade carcinomas, the sensitivity of the ImmunoCyt™ test was 70% (n=20) and 76.4% (n=34) respectively, whereas it was 25% (n=28) and 29.7% (n=37), respectively, for urinary cytology. The differences observed between the sensitivities of the ImmunoCyt™ test and cytology were statistically significant (X2 p<0.05) overall and for Ta and low-grade carcinomas. The sensitivity and specificity of the combination of both tests were 86.8% and 96.2%, respectively. The sensitivity of the combination of both tests for Ta and low-grade carcinomas was 80% (n=20) and 82.3% (n=34), respectively. The ImmunoCyt™ test was diagnostic in 36.2% of tumors overall. Conclusions: In view of the results obtained, we decided to change our follow-up protocol to reduce the number of follow-up cystoscopies by 32.2% in the first 5 years of postoperative follow-up (in a cohort of 140 patients who undergo surgery annually). This benefits patients by reducing the number of urinary infections and iatrogenesis originated by follow-up cystoscopy. In addition, this 32.2% reduction in the number of cystoscopies in 5 years will yield a savings of approximately 35,560 EUR to the health care system in 5 years (AU)

Hepatic metastases from the spindle cell variant of medullary thyroid carcinoma: report of a case with diagnosis by fine needle aspiration biopsy.

BACKGROUND: The liver is a common site of neuroendocrine tumors (NTs) metastatic from primaries in the gastrointestinal tract, pancreas, biliary system and lungs. Medullary thyroid carcinoma (MTC) is also a potential source of metastases of NTs. Their metastases to the liver are frequent and can appear several years after the primitive tumor. Although a wide variety of cytomorphologic features are normally exhibited by MTC in smears, a spindle-shaped cell pattern can predominate, complicating the correct interpretation of a metastasis. CASE: A 63-year-old man presented with multiple liver nodules two years after a total thyroidectomy for MTC. Fine needle aspiration biopsy smears of the liver revealed neoplastic cells occurring in loose groupings or lying singly, most of them with a spindle shape and elongated nucleus with the characteristic "salt and pepper" chromatin pattern of a neuroendocrine tumor. Cytoplasmic dendritic processes and intranuclear inclusions were frequently seen. The cytomorphologic features of the tumor were essentially the same as those of the primary MTC. Immunoreactivity for calcitonin confirmed the diagnosis. CONCLUSION: In fine needle aspiration biopsy of liver masses, knowledge of the spindle pattern of the NT is important in order to achieve a correct diagnosis when metastases are the first manifestation of an occult primary tumor. Among neuroendocrine tumors, MTC must be included in the differential diagnosis.

Extracranial metastasis of a glioma: diagnosis by fine-needle aspiration and immunocytochemistry.

Fine-needle aspiration cytology (FNAC) is a well-established method for the rapid diagnosis of metastatic neoplasms. A case of metastatic glioma to the neck is presented. Diagnosis was made by FNAC combined with immunocytological techniques (glial fibrillary acidic protein). To the best of our knowledge, there have only been six previous cases of metastatic gliomas diagnosed by FNAC. FNAC, combined with clinical history and immunocytochemistry, is a rapid and reliable method in the definitive diagnosis of metastatic gliomas.

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.

Seminal vesicle epithelium as a potential pitfall in the cytodiagnosis of presacral masses. A report of two cases.

BACKGROUND: Whenever abdominoperineal resection is performed because of a rectal adenocarcinoma, the prostate and seminal vesicles may be displaced backward to the presacral space, giving rise to a false radiologic image of a presacral tumor. Due to cytologic atypia associated with the epithelium of seminal vesicles, there is a real possibility, in fine needle aspiration biopsy (FNAB), of erroneously giving a malignant diagnosis. CASES: Two men, aged 53 and 57 years, presented with presacral masses three months and six years, respectively, after abdominoperineal resection for rectal adenocarcinoma. In both cases, FNAB smears showed some groups and single cells with large and irregular nuclei. These cells suggested a recurrence of carcinoma. The presence of cytoplasmic coarse pigment and a background with spermatozoa and blobs of inspissated secretory product were sufficient to determine that these presacral masses represented the seminal vesicles. CONCLUSION: Awareness that seminal vesicles may give rise to a radiologic impression of presacral tumor after abdominoperineal resection of the rectum will avoid unnecessary FNAB and a cytologic false positive diagnosis of colorectal adenocarcinoma.

Aspiration biopsy of pleomorphic lipoma of the breast. A case report.

BACKGROUND: It is well known that subcutaneous lumps in the breast may create diagnostic confusion. We report, for the first time in the cytologic literature, the features of a pleomorphic lipoma in the breast. CASE: Pleomorphic lipoma of the breast was aspirated, showing typical floret cells and mononuclear, hyperchromatic cells with scalloped nuclei, masquerading as malignancy. CONCLUSION: Pleomorphic lipoma has rather typical cytologic features that may allow its recognition when they are present in the proper clinical setting. This report illustrates another diagnostic pitfall in fine needle aspiration biopsy of the breast.

Fine-needle aspiration biopsy of the adrenal glands: A ten-year experience.

We report on our experience in FNA biopsy of the adrenal gland: 177 biopsies performed in the last 10 years. Cytologic diagnoses were divided into four groups: nondiagnostic aspirates (28%), primary adrenal lesions (13%), metastatic neoplasms (33%), and negative cases with known extra-adrenal malignancies (25%). Among diagnostic smears and excluding the latter group, the procedure was 100% specific for malignancy, and 98% of the lesions were correctly diagnosed. There were no known false-positive or false-negative samples. Quality of diagnosis improves with careful smearing (avoids artifacts) and immediate evaluation (raises adequacy rates) by the pathologist. Although the primary or secondary nature of most adrenal masses is readily apparent, it is essential to correlate the clinical, laboratory, and cytologic findings to reach the correct diagnosis. Furthermore, we believe that the primary site of many adrenal metastases must be defined on the basis of clinical data. Diagn. Cytopathol. 1999;21:92-97.

Primary cardiac hydatid cyst in a child. Cytologic diagnosis of a case.

BACKGROUND: Echinococcosis is a troublesome disease, particularly common in sheep-raising communities and usually caused by the cestode Echinococcus granulosus. Although it has been found in almost every organ, isolated cardiac disease is an exceptional presentation since cardiac involvement occurs in only 0.5-3% of echinococcosis cases. CASE: A case of primary cardiac hydatid cyst occurred in a 4-year-old male. The asymptomatic patient was admitted to the hospital for evaluation of an intracardiac cyst. The lesion was successfully excised by open heart surgery, and a definitive diagnosis was made postoperatively by Giemsa staining of hooklets and scolices in cyst fluid. CONCLUSION: This case is of special interest because of the rare site of the lesion and young age of the patient. Pathologists should be alert to the possibility of this parasite appearing in unusual clinical settings.

Value of ultrastructural studies in fine needle aspiration biopsy diagnosis.

We studied 156 fine needle aspiration biopsies of tumors from various locations with electron microscopy and, after processing, obtained evaluable material in 99 (63%) cases. Ultrastructural study elicited highly significant or essential findings in 39 patients (39% of the evaluable samples). In the cases requiring urgent treatment we were able to obtain an ultrastructural diagnosis in seven hours.

Fine needle aspiration biopsy findings in endodermal sinus tumors. A report of four cases with cytologic, immunocytochemical and ultrastructural findings.

We present four cases of endodermal sinus tumor affecting children (median age, 20 months). Three tumors were located in the sacrococcygeal region and one in the right testicle. All cases were diagnosed by fine needle aspiration biopsy. The most characteristic features were cells arranged in a papillary-like configuration, vacuolated cytoplasm and intracellular and extracellular deposits of pink, homogeneous material. Immunocytochemical study showed alpha-fetoprotein-positive cells. Ultrastructural study showed intracytoplasmic inclusions of electron-dense material and basement membrane-like material in the intercellular spaces.

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.

Epithelial atypia in gynecomastia induced by chemotherapeutic drugs. A possible pitfall in fine needle aspiration biopsy.

The clinical, cytopathologic and histopathologic features of a case of gynecomastia induced by chemotherapeutic drugs are described. Fine needle aspiration (FNA) smears showed epithelial atypia, and an erroneous cytologic diagnosis of carcinoma was made. Histopathologic study showed gynecomastia with epitheliosis, papillomatosis and atypical ductal hyperplasia. Review of the FNA smears showed the findings to be more typical of a reparative or regenerative process; these findings had been cytologically overinterpreted, partly due to the lack of adequate clinical information submitted with the aspirate. The possible causes of gynecomastia, the induction of epithelial atypia by cytotoxic chemotherapy and the cytologic features whose recognition may prevent false-positive diagnoses in such cases are discussed.

Fine needle aspiration cytologic findings and differential diagnosis of solitary pseudorheumatoid nodule.

The cytologic findings in fine needle aspirates of two solitary pseudorheumatoid nodules are presented. The main characteristic of the smears was a necrotic granular and filamentous background accompanied by a granulomatous inflammatory infiltrate. The differential diagnosis is analyzed. The results in these cases indicate that the diagnosis of a solitary pseudorheumatoid nodule may be made by fine needle aspiration cytology after a critical evaluation of the cytologic and clinical data and with the help of special stains and microbial culture.

Cytologic, cytochemical, immunocytochemical and ultrastructural diagnosis of a sacrococcygeal chordoma in a fine needle aspiration biopsy specimen.

The cytologic, cytochemical, immunocytochemical and ultrastructural findings on the aspirated material are presented for the case of a 57-year-old man with sacrococcygeal chordoma diagnosed by fine needle aspiration biopsy. Cytologically, two types of cellular elements were differentiated: medium-sized cells with few cytoplasmic vacuoles and classic physaliferous cells. Both types showed marked cytoplasmic positivity for keratin and S-100 protein; the absence of nuclear positivity in the physaliferous cells was notable. Ultrastructural study demonstrated the existence of true intracytoplasmic vacuoles and frequent rough endoplasmic reticulum-mitochondria complexes. The cytologic differential diagnosis with chondrosarcoma, myxoid liposarcoma, ependymoma and metastases of mucosecretory carcinomas is reviewed.

Fine needle aspiration biopsy in the diagnosis of thyroid cancer and thyroid disease.

Fine needle aspiration biopsy (FNAB) performed for diffuse and nodular goiter in the past 5 years, was evaluated in 1399 cases. Surgery was performed on the basis of FNAB cytologic diagnosis that was positive or suggestive of malignancy and/or a suggestive clinical history. Surgery also was performed in cases of cold nodules with negative FNAB results that did not respond to 6 months of suppressive thyroxine therapy. A correlation of cytologic findings with histologic findings was possible in 415 patients who underwent surgery: the evaluation of FNAB results yielded better results when suspicious cytologic findings were considered to be positive (2.4% false-negative, 86.3% sensitivity) rather than negative (6.5% and 65.7%, respectively). FNAB has become a useful procedure in the study and diagnosis of thyroid diseases. It is a simple, rapid diagnostic procedure that may be used to expedite the management of malignant lesions.