Peter Spieler

Soft Tissue and Bone

Various benign and intermediate lesions of soft tissues and bones are listed in the first section. Special interest topics are adipocytic tumors, fibroblastic/myofibroblastic lesions, muscle tumors, schwannoma, and Langerhans cell histiocytosis. A selection of sarcoma from soft tissue and bone is presented in the ‘malignant section’ including relevant immunocytochemical and molecular genetic tests.

Skin Lesions and Unusual Subcutaneous Lesions

This chapter covers (1) common and rare skin lesions of cytologic interest focusing in particular on pilomatrixoma, basal cell carcinoma, malignant melanoma, Merkel cell carcinoma, and primary cutaneous tumors looking-alike metastatic deposits, (2) unusual subcutaneous disorders giving rise to difficulties in standard cytology such as endometriosis and inguinal tumorous mass due to osteoarthritic damage.

Kidney, Adrenal Glands, Retroperitoneum

The section ‘Fine needle aspiration biopsy of kidney’ covers in particular benign cystic and solid tumors, different types of renal cell carcinoma, tumors of the renal pelvis, and renal neoplasms in children and young adults. The latter paragraph focuses on Wilms’ tumor and differential diagnostic aspects against other small round cell tumors. Indication for fine needle aspiration biopsy of adrenal glands, and benign and malignant adrenal lesions are discussed in an other section. Pheochromocytoma is presented in detail including the dilemmas to establish a correct diagnosis in cytologic aspirates.

Oral Cavity and Oropharynx

Performance of brushing and processing of the obtained cell material are key sections in this chapter. Specific interest is directed towards (1) cytologic evaluation of leukoplakia, and (2) the impact of DNA-ploidy measurement in order to ascertain the malignant potential of abnormal squamous cells.

Respiratory Tract and Mediastinum

Normal cytology, abnormal and atypical cells, non-cellular components, and infectious cell changes are largely described together with benign, malignant, and neuroendocrine lesions regarding exfoliative and aspiration cytology of the lung. A separate section broadly addresses diagnostic findings and differential diagnoses in bronchoalveolar washings. The section ‘Fine needle aspiration biopsy of mediastinal disorders’ covers in particular biopsy techniques, accuracy of liquid-based cytology, and the complex lesions of the thymus gland. Cytodiagnostic algorithms of the major benign and malignant pulmonary and mediastinal lesions and their respective differential diagnoses are additionally presented in synoptic setups.

Thyroid and Parathyroid Glands

In this chapter, most benign and malignant lesions of thyroid gland are discussed in detail based on extensive experience in ultrasound-guided fine needle aspiration biopsy. We turn special attention to sample processing, metastatic cancers masquerading as primary thyroid tumor, and to the clinical utility of quantitative DNA image-cytometric analysis. Potential diagnostic pitfalls of aspirates from parathyroidal lesions are emphasized.

Salivary Glands, Head and Neck

In the section ‘Salivary glands’, we mainly focused on crystalloid elements, benign cellular components causing diagnostic confusion, benign lesions of varied type, and benign and malignant neoplasms. Cytologic aspects of common malignant salivary gland tumors - such as mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma - are dealt with in greater detail. The section ‘Head and Neck lesions’ provides a summing up of all congenital masses and their differential diagnoses with special attention to cystic disorders and atypical squamous cells. Furthermore, non-neoplastic and neoplastic cervical lesions are presented that have relevance for differential diagnostic consideration in cytologic practice.

Pancreas, Extrahepatic Bile Ducts, Ampullary Region

In section ‘Fine needle aspiration biopsy of Pancreas’ specific interest is directed towards (1) diagnostic procedures such as endoscopic ultrasound-guided FNAB and pancreaticobiliary duct brushing, (2) advantage and disadvantage of liquid-based cytology, (3) benefit of additive DNA ploidy analysis, (4) non-tumorous and neoplastic cystic disorders, (5) cytology of variably-differentiated ductal adenocarcinomas.

Male Genital Organs

Fine needle aspiration cytology of prostate gland with its benign and malignant disorders is presented in extenso. The ‘benign section’ also focuses on cells aspirated from adjacent organs and tissues. The ‘malignant section’ stresses (1) cytologic appearence of variably differentiated adenocarcinomas, (2) relevance of DNA quantitation as a biological tumor parameter, and (3) morphology of tumor cell regression in consequence of hormonal and radiation therapy.