I. Cozzolino

Fine needle aspiration cytology and flow cytometry immunophenotyping of non-Hodgkin lymphoma: can we do better?

P. Zeppa, E. Vigliar, I. Cozzolino, G. Troncone, M. Picardi, A. De Renzo, F. Grimaldi, F. Pane, A. Vetrani and L. Palombini
Fine needle aspiration cytology and flow cytometry immunophenotyping of non‐Hodgkin lymphoma: can we do better?

Fine needle aspiration cytology of lymphoproliferative lesions of the oral cavity

Oral cavity non‐Hodgkin lymphoma (OCL) is a rare condition that may be clinically and radiologically indistinguishable from other pathologies of the mouth. A complete excision or adequate biopsy of the OCL may be difficult. Fine needle aspiration (FNA) cytology has been successfully utilized in the pre‐operative diagnosis of oral masses and in lymphoma involving other anatomical areas. Our experience with FNA pre‐operative cytological diagnosis of 16 OCLs is reported herein.

Fine-Needle Cytology and Flow Cytometry Assessment of Reactive and Lymphoproliferative Processes of the Breast

Objective: The breast may be affected by reactive and lymphoproliferative processes such as primary (PBL) or secondary (SBL) lymphoma, reactive intramammary lymph nodes and sclerosing lobulitis; imaging may be not specific and surgical treatment not indicated. We report an experience with fine-needle cytology (FNAC) combined with flow cytometry (FC) and immunocytochemistry (ICC) in the diagnosis of these processes. Study Design: Thirty-seven cases comprising intramammary lymph nodes (n = 15), sclerosing lobulitis (n = 2), PBL (n = 11) and SBL (n = 9) are reported. FNAC was used to prepare traditional smears, conventional ICC or FC. Cytological diagnoses were compared to the imaging data, checked by histology or follow-up and statistically evaluated. Results: Imaging was not conclusive in most PBL, SBL, sclerosing lobulitis and some intramammary lymph nodes. FNAC combined with FC and ICC provided a definitive diagnosis of intramammary lymph node, sclerosing lobulitis, PBL and SBL in 18 cases with indication of the specific subtype in 10 cases. Statistical analysis showed 90% sensitivity, 100% specificity, 100% positive predictive value and 89% negative predictive value. Conclusions: FNAC combined with FC and ICC is a helpful procedure for the diagnosis of reactive and lymphoproliferative processes of the breast. It may prevent unnecessary biopsy and speed up therapeutic procedures.

Immunoglobulin heavy and light chains and T-cell receptor beta and gamma chains PCR assessment on cytological samples. A study comparing FTA cards and cryopreserved lymph node fine-needle cytology

To evaluate and compare the DNA yield and quality extracted from lymph node fine needle cytology (FNC) samples stored on FTA cards to those cryopreserved, and to assess the immunoglobulin heavy and light chains (IGHK) and T‐Cell receptor beta and gamma chains (TCRBG) PCR tests.

Bone and soft tissue non-Hodgkin lymphoma of the maxillofacial area: Report of two cases, literature review and new therapeutic strategies

Primary mandibular non-Hodgkin lymphoma (NHL) and soft tissues NHL of the maxillofacial are extremely rare representing a minimal percentage of the head and neck tumors. Two cases of bone and soft tissue maxillofacial NHL are reported. Clinical, radiological and pathological features are described and the therapeutic procedures are discussed accordingly. Mandibular radiologic features have been carefully analyzed and discussed to achieve an early and accurate diagnosis avoiding improper dental therapies.

Histological and fine needle aspiration cytological features of Hashimoto thyroditis‐associated ‘angiomatoid’ papillary thyroid carcinoma

A SFT of the thyroid affects adults and presents as a slow-growing mass composed of fibroblast-like spindle cells; cytological smears show predominantly discohesive slender spindle-shaped cells and fragments of collagenized stromal tissue, as described previously. Similarly an inflammatory pseudotumour of the thyroid gland may be considered in the differential diagnosis although this is a rare lesion demonstrating fibrohistiocytic and myofibroblastic proliferation: the lesion is positive for vimentin and muscle-specific actin but negative for cytokeratin. We believe that the most important factor for making a correct diagnosis of SETTLE is awareness of this entity. This diagnosis must be considered in young patients who present with a swelling in the neck in the region of the thyroid and who do not fit into the usual thyroid tumours on cytomorphology. Immunocytochemistry is very useful in excluding other spindle cell predominant entities especially a medullary carcinoma, a synovial sarcoma and a solitary fibrous tumour, which are the major differential diagnoses of SETTLE.

B‐cell non‐Hodgkin lymphoma and pseudo‐Gaucher cells in a lymph node fine needle aspiration

no follow-up. Microscopic psammoma body calcified structures in cervical smears can be seen in association with benign disorders, including adhesions, benign ovarian tumours, cervical polyps, endometriosis, endosalpingiosis, fallopian tubal cells, intrauterine device, oral contraceptives, pregnancy and sexually transmitted diseases. Malignant disorders associated with psammoma bodies include carcinomas of the cervix, endometrium, ovary, fallopian tube and peritoneum. Benign conditions often have a few associated bland glandular cells versus adherent malignant glandular cells in malignant disorders. Malakoplakia is a granulomatous process that results from impaired phagocytosis of a bacterial infection, particularly Escherichia coli. In this condition, in addition to inflammatory cells, such as histiocytes, lymphocytes and plasma cells, characteristic concentrically laminated calcified spherules, Michaelis–Gutmann bodies, which are pathognomonic for malakoplakia, may be observed. They can be stained by periodic acid–Schiff and for calcium by von Kossa staining. Although malakoplakia is classically described as an inflammatory condition of the genitourinary tract in middle-aged women, it may be associated with a variety of tumours. The typical gynaecological malakoplakia presents with post-menopausal vaginal bleeding. Immunosuppression may be associated with this condition, which has been reported in the literature. The patient in our case was not immunosuppressed. In conclusion, psammomatous-like calcification in uterine malakoplakia may be a diagnostic pitfall for other benign and malignant uterine conditions; the detection of Michaelis–Gutmann bodies helps to confirm malakoplakia.

Molluscum Contagiosum Diagnosis on Nipple Scraping Sample

the 2010 and 2011 mammograms. Despite the possibility that these findings could be attributable to the injections, the findings were considered to be suspicious for malignancy. Stereotactic biopsy of right breast was performed 2 weeks later. The pathology results of focal laminated and nonpolarizable luminal debris with no malignant cells suggested that the mammographic findings were due entirely to the hyaluronic acid injections. Short-term follow-up diagnostic mammography was recommended. Injectable stabilized hyaluronic acid-based gel of nonanimal origin (NASHA) is manufactured by cross-linking hyaluronic acid chains. The result is a molecular network that remains biocompatible but has a significantly longer half-life than endogenous hyaluronic acid. NASHA injection in the breast is most commonly performed as a nonsurgical cosmetic procedure for breast augmentation. In this procedure, hyaluronic acid is injected into a potential space between the pectoralis major muscle and the glandular breast tissue. Hyaluronic acid has also been injected into the reconstructed nipple with the goal of improved nipple contour. However, there are no published studies which evaluate hyaluronic acid injection into the nipple, nor are there any publications regarding the imaging appearance of hyaluronic acid injection into the nipple. The retroareolar branching irregular densities that result from intra-nipple hyaluronic acid injection may lead to biopsy to exclude malignancy. However, awareness of this potential complication may allow biopsy to be avoided, and may lead to future recommendations regarding care of patients who have had intra-nipple hyaluronic acid injection.

Neuroendocrine differentiation in breast carcinoma with osteoclast- like giant cells. Report of a case and review of the literature

Osteoclast-like giant cells (OGCs) may occur in several types of breast carcinomas (BS). Neuroendocrine differentiation may be present in BS but, associated with OGCs, neuroendocrine differentiation has been rarely reported. A case of invasive ductal carcinoma with OGCs and neuroendocrine differentiation diagnosed by fine needle cytology (FNC) is described. A 72-year-old woman with a nodular lesion of the right breast underwent to fine-needle cytology (FNC) The smears showed a dissociated cell population of monomorphous, mononucleated atypical cells with interspersed multinucleated giant cells osteoclast-like. The mononuclear cell component showed plasmacytoid features and frequent vacuoles of secretion. Immunostaining (IHC) performed on cell block sections showed oestrogen receptor positivity in the mononucleated cells and OGCs positivity for LCA and CD68. Histologically the tumour showed cell nests or cords separated by thin fibrovascular septa. The neoplastic cells were monomorphic, with round-oval nuclei, granular chromatin and evident nucleoli. The cytoplasm was indistinct and eosinophilic, finely granular, often containing eosinophilic globules that were positive at the PAS and mucicarmine stainings. Numerous non-neoplastic OGCs were also detected in the interstitial septa. The ICH showed positivity of the tumoral cells for E-Cadherin, oestrogen and progesterone receptors and c-ErbB2 negativity. Mitotic index was inconspicuous with a low Ki67 positivity rate (<10%). OCGs were CD68 and LCA positive. IHC also showed strong positivity for the chromogranin and synaptophysin. A diagnosis of invasive ductal BC with OGCs and neuroendocrine differentiation was performed. The expression of chromogranin and synaptophysin was then retrospectively assessed on CB sections too. The identification of OGCs component on breast FNA samples is not difficult, depending on a good sampling only. On contrary, the neuroendocrine differentiation still represents still a challenge in breast FNC.

Non-Hodgkin Lymphoma

On FNC smears, small-cell NHL generally shows a monomorphous, dissociated, small-size cell population, with little nuclear abnormalities. These features are shared by different entities, corresponding to different subtypes with different clinical behaviours. Therefore, an accurate classification depends only partially upon morphological features, and mainly upon phenotypic and genetic characteristics.