Francisco J. Bilbao

Usefulness and limitations of ultrasound-guided core biopsy in the diagnosis of musculoskeletal tumours†

Ultrasound‐guided needle biopsy is a safe and efficient diagnostic method increasingly used in the initial approach to superficial and deep musculoskeletal tumours. However, so far no general consensus has been reached regarding its reliability. During a 6‐year period (1999–2004), biopsies were taken from 188 patients (100 females, 88 males; age average 55.8 years) with musculoskeletal tumours under ultrasound guidance using 18G BioPince® or 14G ProMag® 2.2 true‐cut type needles. Cytological (imprints and cytocentrifugates) and histological material was obtained for diagnosis in every case. The lower extremity (59 cases) and the abdominal wall (29 cases) were the most commonly affected sites. Benign/reactive tumours (77 cases), metastatic epithelial malignancies (40 cases), and sarcomas (36 cases) were most frequently diagnosed. In 180 (95.75%) cases, core needle results were concordant with the definitive diagnosis (97 true positives and 83 true negatives). Relevant diagnostic discordance was seen in 8 (4.25%) cases (8 false negatives and 0 false positives). Sensitivity, specificity and positive and negative predictive values were 92%, 100%, 100%, and 91%, respectively. Ultrasound‐guided core biopsy is thus a useful method in the initial approach to musculoskeletal tumours that allows correct patient management in the vast majority of cases.

Role of ultrasound-guided core biopsy in the evaluation of spleen pathology.

Core biopsy has not traditionally been recommended in the study of spleen nodules due to the supposed fragility of this organ leading to a high risk of post‐core biopsy complications. A total of 13 patients who presented solid spleen nodules, diffuse splenomegaly, or both on imaging studies (CT, MR, US) were biopsied under ultrasound control with 18G BioPince® needles. Cytological (imprints and cytocentrifugates) and histological material were obtained for diagnosis in every case. Malignant lymphomas were the most commonly found pathology (four diffuse large B‐cell lymphomas, two follicular lymphomas, one Hodgkins disease, one B‐cell lymphoma, NOS). In addition, there was one littoral‐cell angioma, one well‐differentiated neuroendocrine carcinoma, metastatic, and one haemangioma. The remaining two cases showed congestive features, and supposed spleen involvement by lymphoma in one of them was ruled out. On follow up, there were no complications related to the core biopsy. Splenectomy was performed in six cases, two diagnostic and four therapeutic. We conclude that core biopsy is a safe and efficient method in the diagnosis of spleen nodules that could be considered in the routine diagnostic algorithm of these lesions.

Inflammatory myofibroblastic tumour of the larynx

A case of inflammatory myofibroblastic tumour of the larynx in a 74-year old man is reported. The lesion presented as a polypoid tumour arising in the left true vocal fold. The patient died of non-tumour-related causes and the autopsy showed persistence of the laryngeal tumour. Multicentricity and distant metastases were not detected. The literature about this entity and its differential diagnosis is reviewed and briefly commented upon.

Papillary squamous cell carcinoma of the larynx

A case of papillary squamous cell carcinoma of the larynx in a 50-year-old man is reported. The lesion was located in the supraglottic region and grossly presented a characteristic finger-like pattern of growth. The tumour pursued an indolent clinical course, and the patient is well and free of disease after 47 months of follow-up. The present paper recapitulates the macro- and microscopic features of this rare neoplasm and stresses its differential diagnosis with other exophytic squamous cell carcinomas of the region.

Plasmacytoid myoepithelioma of the soft palate. Report of a case with cytologic, immunohistochemical and electron microscopic studies.

BACKGROUND The plasmacytoid variant is a rare and controversial subtype of myoepithelioma that lacks myogenic differentation and the cytologic findings of which have not been reported previously. CASE A 46-year-old man presented with a painless tumor located in the soft palate. Fine needle aspiration cytology (FNAC) showed odd-shaped cellular aggregates and single cells with round nuclei and finely granular cytoplasm resembling plasma cells together with strands of metachromatic stroma. The light, immunohistochemical and ultrastructural studies performed on the surgical specimen confirmed the initial cytologic diagnosis. CONCLUSION Recognition of the cytologic findings of plasmacytoid myoepithelioma on needle aspirates allows a reliable and quick diagnosis that prompts correct management.

Utilidad de la biopsia cilindro guiada por control ecográfico en el diagnóstico y manejo de los tumores renales

Resumen Antecedentes La biopsia guiada por control ecografico esta siendo utilizada de manera creciente en los ultimos anos como aproximacion diagnostica inicial en los tumores renales, aunque su aceptacion entre radiologos y patologos aun no es generalizada. Metodos Durante un periodo de 6 anos (2000-2005), se han biopsiado por este metodo y con agujas 18G un total de 48 tumores renales en 47 pacientes. Resultados Se observo un predominio de varones (34V/13M) y la edad promedio se situo en 51,7 anos (rango 1-92). Treinta y siete (77,1%) casos correspondieron a neoplasias, incluyendo adenocarcinomas renales (25 casos), oncocitomas (3 casos), linfomas (3 casos), tumores de Wilms (2 casos), un tumor carcinoide metastasico, un carcinoma epidermoide metastatico, un nefroma quistico y un sarcoma fusocelular. Cinco casos (10,4%) correspondieron a pseudotumores (3 quistes renales y 2 pielonefritis cronicas). La biopsia proporciono tejido renal normal en 4 casos y tejido fibroadiposo en 2. Se detectaron minimas discrepancias en la adjudicacion de la variante histologica del cancer en 2 casos. Conclusiones La biopsia cilindro guiada por ecografia es un metodo muy util y fiable para el diagnostico de los tumores renales, y deberia ser incluida como herramienta de primera linea en su manejo. Sin embargo, para la obtencion de optimos resultados que puedan llevar a un tratamiento individualizado, se precisa una estrecha colaboracion entre clinicos, radiologos y patologos.

Primary sinonasal ameloblastoma

A case of primary ameloblastoma of the right sinonasal tract in a 66‐year‐old man is reported. The tumour presented as a radiographically solid mass filling the right nasal cavity and sinuses and without continuity with maxillary alveola. After radical surgery plus postoperative radiotherapy, the patient has pursued a non‐aggressive clinical course after nine months of follow‐up. The paper reviews the clinico‐pathological features of this rare tumour and supports the theory of its sinonasal epithelium origin.

Prostatic remnants in mature cystic teratoma of the ovary

Mature cystic teratomas of the ovary containing prostatic remnants are reported in 2 women aged 31 and 20 years. Both cases showed the expected histology of mature teratomas with a mixture of ecto- and endodermal structures lying in a fibrous stroma. In both cases, the foci of prostate tissue were composed of typical prostatic glands arranged in acinar structures. One case displayed a transitional cell-lined duct resembling the urethra. Prostate glands showed intense positive immunostaining with prostatic specific antigen and prostatic acidic phosphatase. Focal images suggesting high-grade prostatic intraepithelial neoplasia were detected in 1 case. The literature on this unusual finding in these common tumors is reviewed and commented on.

Middle-ear carcinoid tumor with distant metastasis and fatal outcome

Hematol Oncol Stem Cell Ther 1(1) January 2008 hemoncstem.edmgr.com 53 The term carcinoid, karzinoid (carcinomaslike), was first mentioned in the literature in 1907 by Oberndorfer.1 Since its recognition as a distinct entity it has been quite a controversial tumor, especially with respect to its biological behavior. In fact, although traditionally considered a benign neoplasm, distant metastases and tumorsrelated deaths were very soon sporadically recorded.1 Carcinoids are exceedingly rare neoplasms in the middle ear2 and are usually referred to as adenoma/ carcinoid tumors because they are considered benign glandsforming neoplasms with an overt tendency to des velop neuroendocrine and mucinous differentiations.3,4 Most literature reviews and textbooks on pathology highlight the benign clinical course of this entity. Some authors, however, have reported in recent years both los cal recurrences and extracranial lymph node metastases in the neck.5s8 Interestingly, no visceral metastases have been reported so far.9 The case reported here represents a unique example of middle ear carcinoid with regional lymph node and liver metastasis that led to the patient’s death after 11 years of follow up.

Orbital giant cell angiofibroma : Report of a recurrent case

A case of giant cell angiofibroma in a 73‐year‐old man is reported. The tumour was located in the upper‐inner quadrant of the right orbit and recurred 16 months after surgical removal. The clinicopathological features of this rare neoplasm–that is nowadays considered a variant of solitary fibrous tumour–are reviewed and briefly commented on.