Radha R. Pai

Fine needle aspiration cytology of the Ewing's sarcoma family of tumors.

OBJECTIVE To study the cytomorphologic features of the Ewings sarcoma (ES) family of tumors. STUDY DESIGN During a period of eight years (1990-1997), 123 soft tissue tumors and 65 bone tumors were evaluated by fine needle aspiration cytology (FNAC); 14 cases were diagnosed as in the ES family of tumors. The ages of the patients ranged from 8 to 30 years. All the cases were histologically confirmed. RESULTS Of 14 cases of the ES family of tumors, 7 were ES, 3 extraosseous ES (EOE), 2 peripheral primitive neuroectodermal tumor (PPNET) and 2 Askin tumor. Cytologically, smears from all the cases showed round tumor cells with a high nuclear/cytoplasmic ratio. On detailed examination, subtle differentiating features were observed. The cells in ES had finer nuclear chromatin in comparison to those of PPNET and Askin tumor, and punched-out clear cytoplasmic vacuoles were present. PPNET showed nuclear molding, unipolar cytoplasmic tags and Homer-Wright rosettes. Histologically, all cases of ES and EOE and one case of Askin tumor showed periodic acid-Schiff-positive inclusions. CONCLUSION FNAC features coupled with clinical findings enable a rapid diagnosis of the ES family of tumors, from which treatment modalities can be determined.

Teratocarcinosarcoma of the nose, paranasal sinuses and nasopharynx

Teratomas affecting the head and neck are rare tumours of ambiguous origin. The benign form is seen in children and mostly affects the nasopharynx. Malignant tumours in the upper jaw have been reported rarely. They are almost exclusively seen in the adult male. They are highly aggressive tumours that are difficult to diagnose pre-operatively due to the varied histological patterns. Treatment options available are surgery, radiotherapy or a combination of both. Despite intensive treatment, the prognosis is still poor. A rare case of teratocarcinosarcoma of the nose, paranasal sinuses and nasopharynx in a 25-year-old male is presented. The tumour had a non-germ cell tumour origin. The clinical features, pathologic characteristics and treatment are detailed. It was managed by surgery, radiotherapy and chemotherapy.

Extramedullary plasmacytoma diagnosed by fine needle aspiration cytology : A report of four cases

BACKGROUND Fine needle aspiration cytology (FNAC) diagnosis of plasmacytoma is rare. CASES Four cases of plasmacytoma were diagnosed by FNAC. The patients had clinically palpable lesions in more than one anatomic site. The sites of aspiration included lymph nodes, soft tissue swellings and a bony mass. The ages of the patients ranged from 42 to 80 years (mean, 62 years), and all the patients were male. All four cases showed a monomorphous population of well-differentiated myeloma cells in aspiration smears. Serum electrophoresis demonstrated an M spike in all cases, and Bence Jones protein was detected in the urine sample in one case. Radiologic and bone marrow findings also substantiated the diagnosis of multiple myeloma. CONCLUSION FNAC diagnosis of plasmacytoma at extramedullary sites offers the opportunity for noninvasive verification of widespread involvement.

Apocrine (cutaneous) sweat gland carcinoma of axilla with signet ring cells: A diagnostic dilemma on fine-needle aspiration cytology

Carcinoma arising in the apocrine sweat glands is rare and there are few reports describing the cytological features of this neoplasm. We describe the cytological features of a histologically confirmed apocrine carcinoma occurring in a 55‐year‐old man who presented with an ulcerated mass in the right axilla. Fine‐needle aspiration cytology revealed features of a signet ring adenocarcinoma. The significance of this infrequently encountered neoplasm lies in its potential for diagnostic confusion with more common lesions containing signet ring cells. In an axillary mass lesion, cytological features along with clinical correlation are essential to distinguish primary apocrine carcinoma from mammary neoplasms with signet ring cells and other metastatic adenocarcinomas. Diagn. Cytopathol. 2008;36:739–741.

Giant hanging melanoma of the eyelid skin

Cutaneous melanoma of the eyelid is a rare entity. We present a 53-year-old male who had a nevus on the left upper eyelid skin since childhood, which transformed into a huge ulcerated hanging mass in the same region. Excision of the mass was done and histopathology confirmed the diagnosis of nodular malignant melanoma. A small preauricular lymph node showed metastatic melanoma on fine needle aspiration cytology.

Metastatic chondrosarcoma in soft tissue diagnosed by fine needle aspiration (FNA) cytology

A 30-year-old man presented with a painful swelling at the tip of left little finger. The swelling measured 2.5 cm in diameter and had a smooth outer surface. Three years before he underwent an above knee amputation for ‘some malignant lesion’, the details of which were not available at that time. His x-ray chest was normal. Fine needle aspiration of the swelling in the finger was performed. Smears were stained with Papanicolaou and May–Grünwald–Giemsa (MGG) stains. The smears were cellular, consisting predominantly of singly placed large polygonal to round cells with hyperchromatic, centrally as well as eccentrically placed nuclei and prominent nucleoli. The cytoplasm was eosinophilic or vacuolated and moderate in amount. Many multinucleated and binucleate cells of similar type were also present. There was bright pink fibrillary metachromatic material in the background (Figure 1). On the basis of these features the diagnosis of chondrosarcoma was suggested. Radiological examination of the finger swelling revealed only soft tissue swelling without bone involvement (Figure 2). Review of the medical records revealed that the patient had had a chondrosarcoma of the right tibia with local soft tissue invasion for which he underwent above knee amputation. In view of the previous report and the present cytological features, the diagnosis of ‘metastatic chondrosarcoma in soft tissue’ was made on FNA cytology. The tumour was subsequently excised by disarticulation of metacarpophalangeal joint of left little finger. On histopathologic examination it showed features of metastatic de-differentiated chondrosarcoma in soft tissue without local skin or bone involvement. On follow up for a period of 1 year the patient has remained healthy and free of any metastasis.

Study of the reproducibility of the 2004 World Health Organization classification of urothelial neoplasms.

The aim of the study was to evaluate urinary bladder biopsies showing papillary urothelial neoplastic lesions based on the 2004 WHO/ISUP classification of Urothelial Neoplasms of the Urinary Bladder, to assess the reproducibility of the bladder carcinoma grade. Fifty consecutive transurethral tumor resection biopsies were evaluated by four pathologists independently. The final diagnoses of each pathologist were subjected to statistical analysis to assess the degree of interobserver variability and reproducibility of this classification. Significant interobserver variation was found in the reporting of urothelial neoplasms. In 22 instances there was difference in opinion between PUNLMP and low-grade carcinoma, and in 59 instances between low and high grade carcinoma. The 4 observers never unanimously agreed on the diagnosis of PUNLMP.

Role of biliary tract cytology in the evaluation of extrahepatic cholestatic jaundice.

Background: Endoscopic evaluation is critical in assessing the cause of obstructive jaundice. Cytological techniques including bile aspiration and biliary brushings have become the initial diagnostic modality. Aim: The aim of this study is to evaluate the role of endoscopic biliary tract cytology as a diagnostic tool in the evaluation of extrahepatic cholestatic jaundice. Materials and Methods: A total of 56 biliary tract specimens including 34 bile aspirations and 22 biliary brushings from 41 consecutive patients who had presented with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) were assessed by cytological examination. The smears prepared were analyzed for standard cytological features. Results: Cytologic diagnosis was adenocarcinoma in 13 (31.7%) cases, atypical in 2 (4.9%), reactive in 3 (7.3%) and benign changes in 19 (46.3%) cases. 4 (9.8%) cases were non-diagnostic. Serum bilirubin was significantly elevated in the malignant group. Biliary stricture was the most common finding on ERCP (68.3%). On cytological examination, presence of solitary, intact atypical cells, enlarged nuclei, irregular nuclear membrane, coarse chromatin and nucleoli were important cytologic criteria for differentiating malignant from benign biliary specimens. Conclusions: Regular use of bile cytology and brushings during ERCP evaluation of extrahepatic cholestatic jaundice is invaluable in obtaining a morphologic diagnosis. A systematic approach, use of strict cytomorphologic criteria and inclusion of significant atypia as malignant diagnosis may improve the sensitivity.

HIV lymphadenitis of the salivary gland: A case with cytological and histological correlation

Human immunodeficiency virus infection associated lymphadenitis of the salivary glands (HIVLSG) and benign lymphoepithelial cysts are described as early events in HIV patients. The diagnosis is not usually made clinically as it mimics a salivary gland tumor. We present here a patient with two painless nodules in the right parotid and submandibular glands. The cytological diagnosis was florid reactive lymphoid hyperplasia. Histopathology revealed features of HIVLSG with multiple, small, cystic, benign lymphoepithelial lesions.

Morphological evaluation of cystitis glandularis.

Cystitis cystica and cystitis glandularis (CG) are relatively common appearances in the urinary bladder though CG may occasionally mimic a neoplasm. Microscopically, two types of CG are recognized, the usual type and intestinal type. This study was undertaken to study the morphology of CG and to highlight the differences in morphology between CG and adenocarcinoma. Eleven cases of CG were seen, of which 3 cases showed predominantly CG, usual type and eight cases showed CG of intestinal type. One case of primary adenocarcinoma was included in this study, where the adjacent bladder mucosa showed CG. Evaluation of the histological features of CG, especially intestinal type helps in correct categorization of this lesion and differentiation from adenocarcinoma of the bladder.