Otal-Salaverri C

HYALINIZING TRABECULAR CARCINOMA OF THE THYROID GLAND : REPORT OF TWO CASES OF FOLLICULAR CELL THYROID CARCINOMA WITH HYALINIZING TRABECULAR PATTERN

Recently tumors have been reported that have an architectural pattern and cellularity similar to hyalinizing trabecular adenoma and show either parafollicular differentiation or histological findings suggestive of malignant neoplasm of the follicular cells. This study describes two cases of thyroid carcinoma of follicular cells that displayed a hylinizing trabecular pattern. The first case was a 25-year-old euthyroid woman with a cold thyroid nodule in the right lobe. On fine needle aspiration a diagnosis of papillary carcinoma was rendered. The thyroidectomy disclosed a 2-cm, firm, brown, encapsulated tumor in the right lobe. The tumor had a growth pattern and cytologic features similar to those described in hyalinizing trabecular adenoma. The differences between these neoplasms were the presence of mitotic figures, prominence of the nucleolus, capsular blood vessel invasion, and microtubule groups in the endoplasmic reticulum. The second case was a 19-year-old euthyroid woman with a cold thyroid nodule in the left lobe. A cytologic diagnosis of follicular proliferation was rendered. A 4-cm, firm, whitish, encapsulated nodule was found in the left lobectomy. The tumor cells were arranged in two clear-cut patterns: a trabecular hyalinizing pattern with a small focus of papillary growth, and a follicular pattern. These findings confirm the existence of malignant thyroid tumors with a hyalinizing trabecular pattern and illustrate the nonspecificity of this peculiar pattern, since it may also be seen in papillary carcinomas of the thyroid. The relationship between hyalinizing trabecular adenoma and papillary carcinoma of the thyroid is commented on.

Robinson cytologic grading of invasive ductal breast carcinoma: correlation with histologic grading and regional lymph node metastasis.

OBJECTIVE To evaluate the importance of cytologic grading of breast carcinoma and its association with histologic grading and the existence of axillary lymph node metastasis. STUDY DESIGN Aspirates and surgical samples from 100 patients with invasive ductal breast carcinoma not otherwise specified were studied. In 50 patients, > or = 1 metastatic nodes were identified. The cytologic grade was evaluated using the Robinson method and the histologic grade using the Elston modification of the Bloom-Richardson method. A study was undertaken to establish the association between histologic and cytologic grades and to compare the various parameters used to evaluate cytologic grade with the presence of axillary node metastasis. RESULTS A statistically significant association was observed between cytologic and histologic grades (p < 0.0005) and between cytologic grade and presence of axillary metastasis (p < 0.0005). Similarly, cell dissociation (p < 0.0005), cell uniformity (p = 0.0010) and the appearance of nuclear margins (p < 0.0005) all displayed a positive correlation with regional metastasis. CONCLUSION Cytologic grade may provide relevant information on the aggressiveness of invasive ductal breast carcinoma and could be a useful parameter to take into consideration when selecting neoadjuvant therapy.

Dipeptidyl aminopeptidase IV in the cytologic diagnosis of thyroid carcinoma.

Recently, the demonstration of DAP IV activity in thyroid cells aspirates has been proposed as an useful tool for the diagnosis of malignancy. We have studied the enzymatic activity of DAP IV, using the modified method of Lodja, in a series of 336 selected aspirates of the thyroid gland with the following cytologic diagnosis: 236 nodular hyperplasias, 60 follicular proliferations, eight Hashimotos thyroiditis, eight Hürthle‐cell proliferations, 20 papillary carcinomas, two anaplastic carcinomas, and two medullary carcinomas. The results were subjectively evaluated on the basis of staining intensity and extension in a minimum of 200 cells. Strong‐to‐moderate enzymatic activity with an extension of more than 40% of the cells were exclusively seen in follicular‐cell derived carcinomas (papillary carcinoma, Hürthle‐cell carcinoma, and follicular carcinoma). Medullary carcinoma, anaplastic carcinoma, and benign conditions were negative or weakly stained. Cytohistologic correlation in 88 patients operated on showed the following results: 26 nodular hyperplasia (18 nodular hyperplasia and eight follicular adenomas), 36 follicular proliferation (24 nodular hyperplasia, six, adenomas, three papillary carcinomas, three follicular carcinomas), two Hürthle‐cell proliferation (one Hürthle‐cell adenoma and one Hürthle‐cell carcinoma), 20 papillary carcinomas, two medullary carcinomas, and two anaplastic carcinomas. DAP IV staining was moderate to strong and extensive in all malignant tumors initially diagnosed as follicular or Hürthle‐cell proliferations.

Fine needle aspiration cytology of an acral myxoinflammatory fibroblastic sarcoma: case report with cytological and cytogenetic findings.

A 29-year-old man presented with a slow-growing, painless mass on the third finger of the left hand. This began as a distal swelling but later progressed towards the palm, eventually affecting the whole finger. The patient underwent surgery to drain abundant mucoid material; the initial surgical diagnosis was a large ganglion cyst. One month later, the patient consulted because of a new swelling affecting the distal twothirds of the finger (Figure 1). Fine needle aspiration was performed. What is your diagnosis? Acral myxoinflammatory fibroblastic sarcoma (AMIFS) is the most recent form of fibrosarcoma to be reported so far. It is considered to be a unique lowgrade sarcoma with myxoid stroma, inflammatory infiltrate and virocyte-like cells (WHO) that may readily be confused with inflammatory processes, such as pigmented villonodular tenosynovitis, or various reactive fibroinflammatory processes. One of its distinctive features is a preference for the hands and feet, but it has also been reported in more proximal areas, such as the forearm, upper arm, thigh and even the neck. Its clinical, histological, inmunohistochemical and ultrastructural features have been well documented in several series, but few reports are available on fine needle aspiration (FNA) cytology findings. Cytogenetic reports are also scarce. Two reports describing complex karyotypes present different findings: a reciprocal translocation between chromosomes 1 and 10 t(1;10)(p22;q24) with loss of chromosomes 3 and 13, as against supernumerary ring chromosomes and a derivative chromosome 13, with additional material on the short arm. This paper reports on the cytological and cytogenetic findings in a recurrent AMIFS on the third finger of the left hand of a young adult.

Robinson Cytologic Grading in Invasive Ductal Carcinoma of the Breast

OBJECTIVE To correlate the cytologic grade of breast carcinoma with the expression of E-cadherin/catenin system molecules and the presence of metastasis in regional lymph nodes. STUDY DESIGN Aspirate smears were examined together with histologic sections from the corresponding neoplasms taken from 100 patients with invasive ductal carcinoma. In 50 cases, > or = 1 metastatic nodes were identified. Cytologic grading of the smears was performed using the Robinson method. Immunohistochemical expression of E-cadherin and of alpha-, beta- and gamma-catenin was studied. RESULTS A statistically significant relationship was observed between E-cadherin/catenin expression and cytologic grade (p < 0.0005). This association was particularly relevant to the cell dissociation parameter (p < 0.0005). CONCLUSION The cytological grade established in preoperative studies may provide relevant information on the aggressiveness of invasive ductal carcinoma and its tendency to produce regional metastasis. This finding could be particularly useful in cases of breast carcinoma in which neoadjuvant therapy is the method of choice.

Cytological diagnosis of a presacral myelolipoma: A case report diagnosed by fine‐needle aspiration

Dear Dr. Bedrossian: Presacral myelolipomas (PML) are rare benign soft-tissue neoplasm with less than 20 previous cases reported. These are usually incidentally found on imaging studies performed in the work-up of vague digestive and/or urinary symptoms. Myelolipoma is an encapsulated tumor consisting in an admixture of mature adipose tissue and hematopoietic cells of all lineages. It also frequently shows scattered lymphoid aggregates. Previous studies have shown that an accurate diagnosis can be established by fine-needle aspiration (FNA). A 64-year-old Caucasian female presented with vague abdominal pain, constipation, nausea, and vomiting. The patient’s past medical history was significant for congestive heart failure secondary to constrictive pericarditis, chronic atrial fibrillation, peripheral venous insufficiency, and tuberculosis of the lung. Biochemical analysis and blood count did not reveal abnormal results. An abdominal-CT showed a presacral heterogeneous mass, 8 3 6.5 cm, thought to contain both fat and soft tissue. A CT-guided FNA was performed using an 18-gauge needle (Fig. 1). The air-dried Diff Quick-stained smears showed trilineage hematopoietic elements admixed with scattered lymphoid cells against a background of mature fat cells (Figs. 2 and 3A and B). Megakaryocytic cells were demonstrated by Factor VIII immunostain (Fig. 3C). A diagnosis of myelolipoma was made on the basis of these cytological features in conjunction with the radiological features. The patient refused the surgical excision of the neoplasm. Myelolipomas are benign soft-tissue neoplasms composed of an admixture of normal bone marrow elements and mature adipose tissue. They frequently occur in the adrenal gland being exceptional in extra-adrenal locations.