Rajan Chopra

Pleomorphic adenoma: Cytologic variations and potential diagnostic pitfalls

The diverse morphological features encountered in pleomorphic adenoma (PA) may cause diagnostic errors in fine needle aspiration cytology (FNAC). The present study was performed to evaluate the variations in the cytological features of pleomorphic adenoma and to assess the efficacy of FNAC in its diagnosis. Fifty cases diagnosed as PA on FNAC were retrieved from the records of the Pathology Department. Cytologic smears and sections were reviewed and the cytologic diagnoses were compared with the definitive histologic diagnoses. In cases correctly diagnosed on aspiration, morphological variables like patterns of the epithelial component, type and extent of the mesenchymal matrix, metaplastic cells, hyaline globules, cystic change, giant cells, crystalline deposits, nuclear inclusions/grooves, and nuclear atypia were evaluated. The extreme diversity in morphologic features seen in histologic sections was reflected in the smears of PA. Metaplastic changes were observed more frequently in sections, while nuclear changes like inclusions/grooves were more commonly seen in smears. Other morphological features like cylindromatous pattern, giant cells and crystalline deposits were observed with equal frequency in smears and sections. Cytohistologic agreement was present in 45 of the 50 cases (90%). In 5 cases diagnosed as pleomorphic adenoma on FNAC, the histology revealed 1 case each of schwannoma, perineurioma, ectomesenchymal chondromyxoid tumor of tongue, adenoid cystic carcinoma and mucoepidermoid carcinoma. FNAC is a fairly accurate pre‐operative procedure for the diagnosis of PA. The cytopathologist needs to be aware of the cytologic variations in pleomorphic adenoma so as to avoid diagnostic errors. Diagn. Cytopathol. 2009.

Cutaneous metastases of internal malignancies: A clinicopathologic study

BACKGROUND Secondary tumor deposits in the skin represent advanced malignancy and are of uncommon occurrence. The clinical presentation of these lesions is variable, and the clinical impression is rarely correct, except in cases of known primary malignancies. AIM To summarize the clinical and histopathological findings in biopsy-proven cutaneous metastases. METHODS The present study has analyzed 14 cases of cutaneous metastases from internal malignant neoplasms, excluding hematolymphoid neoplasms. The clinical parameters analyzed include presentation of deposits and their relation to the primary tumor. The histological features of cutaneous metastases were compared with the primary tumors and the frequency of common features in them were evaluated. RESULTS Cutaneous metastases from internal organ malignancies showed a prevalence rate of approximately 2%. Eight cases (56%) presented as primary manifestations of the tumor; biopsy evaluation in these cases suggested the possible primary tumor site and triggered further evaluation and imaging studies. Four patients, undergoing treatment for a known malignant tumor, had recurrence of the tumor in the form of cutaneous metastatic deposits. In the remaining two patients, cutaneous metastases of the tumor appeared simultaneously with the primary neoplasm and represented a higher stage of malignancy. CONCLUSIONS Skin biopsy findings were significant in all cases. The morphological patterns of cutaneous metastases corresponded with the primary tumors and their evaluation helped localize unknown primary malignancies. In cases with known primaries, cutaneous metastases upstaged the malignancy and affected the prognosis.

Ectomesenchymal Chondromyxoid Tumor of the Tongue Masquerading as Pleomorphic Adenoma on Fine Needle Aspiration Cytology Smears: A Case Report

BACKGROUND Ectomesenchymal chondromyxoid tumor (ECMT) of the tongue is a relatively uncommonly recognized entity, first characterized in 1995 when Smith et al described the clinicopathologic features in 19 cases. The reported incidence of this tumor is still limited, and the recognition of its presenting features is not widespread. Although the tumor histology is typical, the fine needle aspiration cytology (FNAC) features can be mistaken for those of other myxoid lesions. CASE A 47-year-old woman presented with a nodule on the dorsal surface of the tongue that had been present for 3 months. Fine needle aspiration smears from the nodule showed abundant myxoid to fibrillary stromal fragments and clusters of oval and polygonal to spindled cells with uniform nuclei. A cytologic diagnosis of pleomorphic adenoma was given. Subsequent histopathologic evaluation of the excised tumor revealed ECMT. CONCLUSION Because of its abundant chondromyxoid stroma, ECMT shares morphologic similarities with other myxoid lesions, especially the salivary gland tumors, on histologic evaluation. The FNAC features of this tumor have not been reported before. The lack of awareness of ECMT as a tumor entity and nonexposure to the cytologic features may cause errors in the cytologic diagnosis.

Panniculitis: clinical overlap and the significance of biopsy findings

Background: Panniculitides are well‐recognized clinicopathologic entities but the non‐specificity of their clinical and pathological features often troubles the diagnostician.

Cytomorphologic Features of Chondroid Neoplasms: A Comparative Study

OBJECTIVE To perform a comparative analysis of fine needle aspiration cytology (FNAC) features of chondroid tumors and their significance in diagnosis. STUDY DESIGN A retrospective evaluation of 17 chondroid tumors diagnosed by FNAC was done. Cytologic features were detailed and compared among different chondroid tumor types and with available histology. RESULTS The 17 cases comprised enchondroma (5), osteochondroma (1), chondroblastoma (2), chondromyxoid fibroma (2) and chondrosarcoma (7). Chondroblastoma and chondromyxoid fibroma were specifically diagnosed in all 4 cases by FNAC due to characteristic cytology. However, the cytologic appearance of enchondromas overlapped significantly with that of well-differentiated chondrosarcoma, but the correct diagnosis was made by interpreting cytology with clinicoradiologic correlation. The cytologic features of high chondroid fragment cellularity, irregular cell arrangement in fragments, prominent nucleoli, and moderate to severe nuclear hyperchromasia and mitotic activity were limited to chondrosarcoma. The single error consisted of a case of osteogenic sarcoma, chondroblastic type, that was interpreted as chondrosarcoma. CONCLUSION FNAC smears interpreted in the light of clinical and radiologic findings demonstrated high diagnostic accuracy. It is important to be aware of the cytology of uncommon chondroid tumors such as chondroblastoma and chondromyxoid fibroma as well as of the overlap of cytologic features between enchondroma and chondrosarcoma to avoid diagnostic pitfalls.

Left-sided gastroschisis with meromelia of the limbs : A rare association

Gastroschisis is a malformation of the anterior abdominal wall that presents as herniation of abdominal contents through a paramedian abdominal defect, usually to the right side of the midline. The defect involves all the layers of the abdominal wall and there is no membranous covering. In newborns with isolated gastroschisis, the overall prognosis is very good. In rare cases, gastroschisis is associated with other congenital malformations, making the prognosis worse. We herein report a rare case of left‐sided gastroschisis associated with meromelia of the limbs.

Fine needle aspiration cytology diagnosis of tailgut cyst: a rare entity.

Background: Tailgut cyst is a rare tumor believed to originate from small portions of the embryonic tailgut, which normally disappear in early fetal development. It is often misdiagnosed due to the general unfamiliarity with this entity and also because of its clinical presentation similar to other more common diseases such as perianal fistulas and abscesses. Case: The authors take this opportunity to report a case of tailgut cyst in a 21-year-old Saudi female. The patient had presented with painful low back swelling, which had been gradually increasing in size. The case was diagnosed by fine needle aspiration cytology (FNAC) as tailgut cyst and later confirmed by histopathology. Conclusion: Tailgut cysts are congenital cystic hamartomatous lesions, which are rare in occurrence. They are generally benign, but malignancy has also been reported, which is even rarer in occurrence. FNAC is an effective diagnostic tool, which if applied appropriately can be used for the early detection of rarer lesions such as tailgut cyst.

Reviewers And Consultants, Vol. 54, 2010

Fadi W. Abdul-Karim Pedro P. de Agustín Måns Åkerman Mousa A. Al-Abbadi Syed Z. Ali Patricia Alonso de Ruiz Karen M. Atkison Silvana Audy-Jurkovic R. Marshall Austin Ulrik Baandrup Zubair W. Baloch Markus Bangerter Oralia Barboza Quintana Aasmund Berner George G. Birdsong Thomas A. Bonfiglio Mathilde E. Boon Lukas Bubendorf Jorge Campos R. de C. Tien-Chun Chang Guangchun Chen Edmund S. Cibas Terence J. Colgan Luiz Martins Collaco Brian T. Collins William N. Crabtree Yahya Daneshbod Dilip K. Das Mina Desai Pranab Dey Wenancjusz M. Domagala Liu Dongge Antonio Ducrot-Schinini Jaroslava Dus̆ková Hormoz Ehya Yener S. Erozan Canan Ersöz Guido Fadda Annabelle Farnsworth Peter N. G. Fitzgerald Brendan T. Fitzpatrick Daniel Fontaine Kim R. Geisinger Claude Gompel Ricardo González-Cámpora Zenon Gonzalez-Romero Roberta M. Goodell Mai Gu Prabodh K. Gupta Raj K. Gupta Xhevdet Harasani Amanda Herbert Anders Hjerpe Yajue Huang Lucrecia T. Illescas Rohit Jain Matías Jiménez-Ayala So-Young Jin William W. Johnston David B. Kaminsky Kusum Kapila Harubumi Kato Ruth L. Katz Karim Khetani Ui-Soon Khoo Bryan Knight Tadao K. Kobayashi Leopold G. Koss Helen A. Koutselini Rainer Kraft Leena Krogerus Sow-Hsong Kuo Hiroyuki Kuramoto Gladwyn Leiman Marianne Lidang Oscar Lin Virginia A. LiVolsi Britt-Marie Ljung The editors and publisher are grateful to the following individuals for their assistance in evaluating manuscripts for publication in the journal. It is only through their efforts that Acta Cytologica is able to maintain the high scientific standards for which it is known.