Andrés Pérez-Barrios

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 ofmalignant lesions. Cancer 59:1206‐1209, 1987.

Fine Needle Aspiration of Chromophobe Renal Cell Carcinoma

OBJECTIVE To describe the cytomorphologic findings of chromophobe renal cell carcinoma (CRCC) in order to preoperatively distinguish this rare neoplasm from other primary or secondary tumors arising from the kidney or presenting as retroperitoneal masses. STUDY DESIGN Clinical data, fine needle aspiration (FNA) and follow-up surgical specimens from 4 patients with CRCC (3 primaries and 1 metastatic to the liver) were reviewed. Electron microscopy was available for 2 histologic specimens. RESULTS Two tumors (1 primary and 1 metastatic case) were readily identified as CRCC on FNA. The 2 remaining cases were diagnosed as renal cell carcinoma (RCC) consistent with CRCC. All tumors showed aspirates with moderate to high cellularity, with the cells arranged in small clusters and single cells. Neoplastic cells had abundant heterogeneous cytoplasm, a thickened cell membrane, nuclear hyperchromasia, nuclear outline irregularity, significant nuclear size variation, intranuclear inclusions and frequent binucleation. Histology of the 4 renal tumors was characteristic of CRCC, with positivity for Hales colloidal iron in all cases. Ultrastructurally, characteristic cytoplasmic microvesicles were observed in the 2 cases that we studied. CONCLUSION In the adequate clinicoradiologic setting, CRCC has distinctive cytologic features that may allow an accurate preoperative FNA diagnosis.

Fine‐needle aspiration cytology diagnosis of metastatic nonhaematological neoplasms of the breast: A series of seven cases

Metastatic neoplasms of the breast are rare. Mammary metastases as the initial presentation are even more infrequent and can simulate a primary malignancy clinically and radiologically. Recognition of metastatic tumors in the breast is important because it would prevent unnecessary mutilating surgery and would lead to appropriate treatment of the primary tumor. There is a broad variety of cytological appearances reported about primary tumors and few reports about secondary breast malignancies, specially diagnosed by FNAC. This study was carried out to examine the clinical and cytomorphologic features of metastatic breast tumors found in 12 de Octubre University Hospital during a period of 20 years. It confirms the utility of FNAC and describes findings that can help in the differential diagnosis that sometimes can be very difficult.

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.

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.

Primary papillary serous carcinoma of the peritoneum : Report of a case with diagnosis by fine needle aspiration and immunocytochemistry

BACKGROUND Primary papillary serous carcinoma (PPSC) of the peritoneum is a rare neoplasm, histologically indistinguishable from papillary serous carcinoma of the ovary, which diffusely involves the peritoneum but spares or minimally invades the ovaries. To the best of our knowledge, the preoperative and the fine needle aspiration diagnosis of this disorder have not been reported before. CASE A woman developed an extensive peritoneal neoplasm 4 years after hysterectomy and bilateral salpingo-oophorectomy for benign disease. Fine needle aspiration of the tumor was performed, and the cytologic and immunocytochemical findings were consistent with papillary serous carcinoma. A diagnosis of PPSC of the peritoneum was rendered because review of all slides from previous surgical specimens showed no evidence of carcinoma and no other primary tumors were found elsewhere. CONCLUSION Fine needle aspiration cytology coupled with immunocytochemical and clinical data allows an unequivocal preoperative diagnosis of papillary serous carcinoma (primary peritoneal or with an ovarian origin). The sole limitation to establish a primary peritoneal origin before surgery is the requirement to histologically study the ovaries. Based on this fact, the preoperative fine needle aspiration cytology diagnosis of PSCP should be restricted to oophorectomized patients.

Protocolo y guía para el diagnóstico histopatológico de carcinoma hepatocelular

Resumen Este protocolo-guia para el diagnostico histopatologico del carcinoma hepatocelular es un documento de trabajo de la Subcomision de Tumores Digestivos del Hospital 12 de Octubre que pretende consensuar un acuerdo intrahospitalario para la utilizacion de las nomenclaturas acreditadas en la literatura de forma que sean homogeneas y uniformes para evitar malentendidos que lleven a conductas diferentes en el manejo de pacientes con el mismo tipo de lesion. Asimismo, intenta informar a clinicos y radiologos de lo que pueden esperar del diagnostico citohistologico de los posibles especimenes de un paciente con diagnostico sospechado o confirmado de carcinoma hepatocelular.