Nuria Alberti

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.

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.

X‐linked agammaglobulinaemia and squamous lung cancer

A 32yr-old nonsmoking male, diagnosed as having X-linked agamma-globulinemia, presented with fever, cough with purulent sputum, a very intense back pain and a mass of 10 centimetres in lower left lobe. Diagnostic evaluation revealed a squamous cell carcinoma with very aggressive metastases at L3. Malignancies are the second leading cause of death in children and adults with congenital immunodeficiency disorders, mostly non-Hodgkin lymphomas and gastric and colon adenocarcinomas, but this is the first report of lung cancer in a patient with X-linked agammaglobulinemia. Lung cancer incidence has been reported to be higher in patients with other diseases of the lung, however, there is no clear evidence of the role of bronchiectasis in developing lung cancer. It is possible that a longer survival for patients with X-LA recently diagnosed, and an association of chronic bronchial infection, could favour the development of pulmonary neoplasm.

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.

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. Diagn. Cytopathol. 23:43–45, 2000.