Henryk A. Domanski

Cytology of pilomatrixoma (calcifying epithelioma of Malherbe) in fine needle aspirates

OBJECTIVE To characterize the cytomorphologic features of pilomatrixoma. STUDY DESIGN Aspirate findings in nine cases of PMX were correlated with clinical data and subsequent histology. This relatively large volume of case material afforded an opportunity to test the cytologic criteria that have been proposed as diagnostic of pilomatrixoma in the case reports published previously. RESULTS Ghost cells, basaloid cells and calcium deposits were the features found to be most characteristic of PMX and were observed in all four cases in which a correct diagnosis was made originally. CONCLUSION The presence of ghost cells seems to be the key to recognizing PMX. These cells are visible in the majority of air-dried smears but seldom in alcohol-fixed smears. Adequate cytologic sampling and the routine use of both wet-fixed and air-dried smears should preclude an incorrect diagnosis.

Adult rhabdomyoma in fine needle aspirates : A report of two cases

BACKGROUND Adult rhabdomyoma (ARh) is a rare, benign tumor arising most frequently in the head and neck region and sometimes mimicking malignant tumors clinically. Correct preoperative evaluation of this tumor is of crucial importance as its treatment is complete excision only and not radical surgery. CASES Two patients with ARh, one tumor presenting near the submandibular gland and the other in the thyroid area, are reported. The first tumor was correctly diagnosed by fine needle aspiration cytology. The second, clinically suspected to be a colloid goiter, was preoperatively diagnosed as such cytologically as well. After the tumor was excised, reexamination of the cytologic specimen disclosed follicle cells admixed with single cells from ARh; these had been interpreted as colloid fragments at the time of primary evaluation. CONCLUSION Fine needle aspiration evaluation of ARh may be problematic due to the rarity of the tumor and to the similarity of the tumor cells to normal striated muscle and to other tumors in which cells with abundant granular cytoplasm are characteristic. With an awareness of the cytologic features of this uncommon tumor, cytopathologists can render a correct diagnosis.

Skin and Subcutis

Morphologic diagnosis of skin lesions is traditionally performed with punch biopsies or incisional biopsies. Skin nodules are excised for both curative and diagnostic purposes. Fine-needle aspiration cytology (FNA) offers the possibility of avoiding surgical biopsy and provides rapid diagnosis.

Intravenous pyogenic granuloma mimicking pleomorphic adenoma in a fine needle aspirate : A case report

BACKGROUND Intravenous pyogenic granuloma (IvPG) is a rare, benign lesion occurring usually as a subcutaneous mass in the neck or upper extremity. The cytologic features of IvPG have not been described before. CASE A patient presented with a subcutaneous nodule on the lower border of the left parotid area. The clinical diagnosis was bronchial cleft cyst or lymphadenitis, and the fine needle aspiration diagnosis was pleomorphic adenoma. The tissue section, however, disclosed IvPG. CONCLUSION Evaluation of subcutaneous nodules presenting cytologically as spindle cell lesions may be problematic, particularly in the neck and head region. Such lesions occurring in the parotid area may be interpreted as pleomorphic adenoma of the salivary gland.

Orbit and Ocular Adnexa

The orbital area contains a variety of anatomical structures including the eyelids, tarsal conjunctiva, caruncle, lacrimal gland, lacrimal drainage system, skin, skin adnexa, and soft tissues. It is surrounded by bone and cartilaginous structures and is highly vascularized and interspersed by the cranial nerves. This complex of neighboring, highly specialized tissues results in a large spectrum of inflammatory, benign, and malignant conditions. An extensive blood supply of the richly vascularized orbital area explains the occurrence of metastases from various organs, commonly from breast and lung neoplasms in adults and neuroblastoma in children. Fine-needle aspiration (FNA), by its simplicity and accuracy, can serve as an important diagnostic tool, solving some of the various clinical dilemmas in this complex anatomic area.

Image-Guided Fine-Needle Aspiration Cytology

Several factors make image guidance necessary in fine-needle aspiration cytology (FNAC): A lesion is diffuse and difficult to palpate; the cytologist requires it for all deep-seated nonpalpable lesions; there may be sampling issues in a nonhomogeneous lesion with areas of different tissue characteristics (e.g., necrosis versus viable tumor or purely fatty areas versus contrast-enhancing areas in liposarcomas); and/or the lesion may be inaccessible behind bony structures or located inside bone. In many cases, the cytologist may simply prefer to use image guidance for a more exact needle placement. In all cases, however, the first step should be a thorough and careful review of all pertinent imaging studies to select the appropriate guiding modality, evaluate all possible access routes, and select appropriate needles and devices to reach the lesion. At this stage, the patient should also be considered: Is there coagulopathy or is the patient on an anticoagulant, antiplatelet, or thrombolytic medication? Are there any other absolute or relative contraindications to the procedure or to any imaging modality (e.g., magnetic resonance imaging [MRI])? If needed, the coagulant status should be corrected to acceptable levels.

Non-round Cell Sarcomas

Non-round cell sarcomas may occur in children or young adolescents. We present some examples of the most common entities: epithelioid sarcoma, osteosarcoma; malignant peripheral nerve sheath tumor (MPNST), congenital infantile fibrosarcoma, and synovial sarcoma.

The cytological diagnosis of metastases to the brest from extramammary malignancies; a cytomorphologic study with emphasis on ancillary techniques

Metastatic neoplasm to the breast is a rare and heterogeneous event which can mimic primary breast carcinoma or benign neoplasm. Distinguishing metastasis from primary breast carcinoma is very important because of the difference in treatment options. This study aimed to investigate the diagnostic utility of fine-needle aspiration biopsy (FNAB) in differentiating breast metastases from primary breast neoplasm. FNAB of 50 metastases to the breast were evaluated for the following: cytomorphology, influence of clinical history and adjunctive methods on the final diagnosis. Reliable cytological criteria of malignancy were found in all 50 smears. These criteria, correlated with clinical data or complemented by ancillary techniques in selected cases, allowed correct diagnosis in 48 patients. Of the remaining two cases, wrongly diagnosed as primary carcinoma, one patient presented with a breast mass and the other had a history of intestinal carcinoid. FNAB plays an important role in the separation of metastatic neoplasm in the breast from primary breast carcinoma. Recognition of unusual cytomorphologic patterns, awareness of patient history and, in selected cases, ancillary techniques, are necessary in rendering a correct diagnosis of breast metastasis in FNAB smears.

Mediastinum and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Due to the complex anatomy of the mediastinum and its proximity to a number of organs, a variety of neoplastic and nonneoplastic lesions may occur in the mediastinum. The majority of these are accessible via fine-needle aspiration cytology (FNAC). The main indication for FNA in the mediastinum is to distinguish between neoplasm and nonneoplastic conditions and between benign and malignant neoplasm. FNA of the mediastinum has been successfully used for the confirmation of metastasis from different origins. Since the introduction of FNA guided by endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS), its use has rapidly increased in staging of lung carcinoma and in establishing the mediastinal lymph node status in other malignancies. In addition, FNA of the mediastinum has been increasingly accepted as a diagnostic modality in the investigation of primary mediastinal neoplasm.

Head and Neck: Salivary Glands

A large panorama of lesions is accessible to fine-needle aspiration cytology (FNAC). This chapter focuses on lesions of the salivary glands, as well as tumors of the tongue and oral and nasal cavities. Some unusual lesions of the neck will also be presented. Aspiration cytology of thyroid and lymph nodes is dealt with in other chapters. When confronted with a mass lesion in the head and neck area, it is not always obvious which organ or structure is involved or where a tumor originates. The widespread distribution of minor salivary glands, for instance, implies that tumors originating from these glands may present in unexpected sites. Aspiration cytology therefore can play an important role in clarifying the basic question of tumor origin.