Syed Z. Ali

Solitary fibrous tumor : A cytologic-histologic study with clinical, radiologic, and immunohistochemical correlations

Solitary fibrous tumors (SFT) are rare neoplasms that most commonly involve the pleura, mediastinum, and lung. They are believed to be submesothelial in origin. Histologically, they are characterized by fibroblast‐like cells and connective tissue in varying proportions. The “patternless pattern” and the hemangiopericytoma‐like pattern are the most common arrangements. The majority of SFTs have been immunoreactive for CD34. Very little has been reported regarding the cytologic findings in these tumors.

Techniques for thyroid FNA: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference.

The National Cancer Institute (NCI) sponsored the NCI Thyroid fine‐needle aspiration (FNA) State of the Science Conference on October 22–23, 2007 in Bethesda, MD. The 2‐day meeting was accompanied by a permanent informational website and several on‐line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters addressing manual and ultrasound guided FNA technique and related issues. Specific topics covered include details regarding aspiration needles, devices, and methods, including the use of core needle biopsy; the pros and cons of anesthesia; the influence of thyroid lesion location, size, and characteristics on technique; the role of ultrasound in the FNA of a palpable thyroid nodule; the advantages and disadvantages of various specialists performing a biopsy; the optimal number of passes and tissue preparation methods; sample adequacy criteria for solid and cystic nodules, and management of adverse reactions from the procedure. (http://thyroidfna.cancer.gov/pages/info/agenda/) Diagn. Cytopathol. 2008;36:407–424.

Primary pancreatic lymphomas: a cytopathologic analysis of a rare malignancy.

Primary pancreatic lymphomas (PPL) are extremely rare. Clinically, PPL usually present with symptoms of carcinoma of the pancreatic head. An accurate cytopathologic diagnosis by fine‐needle aspiration (FNA) is imperative because the primary treatment is nonsurgical, based on a combination of chemotherapy and radiation therapy.

Diagnostic accuracy and pitfalls in fine-needle aspiration interpretation of Warthin tumor

Despite its well‐defined histologic appearance, the often variegated cytomorphologic appearance of Warthin tumor (WT) on fine‐needle aspiration (FNA) may lead to an erroneous cytopathologic interpretation. In this study, the authors analyzed the potential sources of diagnostic errors and overall accuracy of FNA diagnosis of WT.

Lymphoepithelial cyst (LEC) of the pancreas: cytomorphology and differential diagnosis on fine-needle aspiration (FNA).

Lymphoepithelial cyst (LEC) of the pancreas is an extremely rare benign entity. We describe the cytopathologic findings of such a lesion in a 49‐yr‐old woman who was examined for epigastric pain. A trans‐esophageal ultrasound‐guided fine‐needle aspiration of a pancreatic mass disclosed an intimate mixture of squamous epithelial cells and small, mature lymphocytes in a background of keratinaceous debris, anucleate squames, and multinucleated histiocytes. On histopathologic examination, a subsequent resection showed a multiloculated cystic lesion with a stratified squamous epithelial lining surrounded by well‐formed lymphoid tissue, suggestive of LEC. The differential diagnosis includes other pancreatic pseudocysts, dermoid cyst, mucinous cystic neoplasms, adenosquamous carcinoma, and metastatic squamous cell carcinoma. Diagn. Cytopathol. 1999;20:371–374.

Parathyroid hormone assay in fine‐needle aspirate is useful in differentiating inadvertently sampled parathyroid tissue from thyroid lesions

To assess the utility of chemical analysis for parathyroid hormone in the rinse (PTH‐r) obtained via fine‐needle aspiration (FNA) in the setting of inadvertently sampled parathyroid tissue or lesions (PTL) during “thyroid” or “neck” FNA, the authors review their experience at a large, tertiary care academic medical center. All cases of inadvertent sampling of PTL during “thyroid” or “neck” FNA were identified by computer search. The cytologic and histologic material was reviewed and pertinent clinical data including patient demographics, serum calcium, intact serum PTH (PTH‐s), and intact PTH‐r was recorded. The cytologic interpretations and histologic diagnoses were also recorded. Of 3,521 cases of total thyroid and neck FNA during the study 21 (0.59%) cases of histologically confirmed sampling of PTL were identified. In all 10 cases with PTH‐r the level was markedly elevated (range 248–240,075 pg/mL) and in every case PTH‐r/PTH‐s was elevated (range 3.67–458.3). In all 10 cases with PTH‐r the cytologic diagnosis was PTL or included PTL in the differential. In 4/11 cases without PTL‐r diagnoses of thyroid neoplasm or suspicious for thyroid neoplasm were rendered, each resulting in thyroidectomy. PTH‐r has utility in differentiating PTL from thyroid lesions in the setting of inadvertent sampling of PTL during thyroid or neck FNA. Cellular specimens with features not typical for thyroid lesions should be triaged for PTL‐r. Routine use of PTH‐r will result in appropriate triage of patients to less aggressive excisional biopsies rather than unnecessary thyroidectomy. Diagn. Cytopathol. 2008;36:227–231.

A spectrum of cytomorphologic variations in medullary thyroid carcinoma. Fine-needle aspiration findings in 19 cases.

Medullary thyroid carcinoma (MTC), a rare malignancy with a variety of morphologic appearances, can mimic both primary and metastatic lesions of the thyroid gland and give rise to diagnostic problems when these tumors are aspirated. Although cytopathologic features of MTC have been well described, this study was undertaken to define and elaborate further, subtle morphologic variations, the recognition of which would be helpful in the diagnosis of MTC.

Lymphoid lesions of the parotid

Lymphoid lesions of the parotid gland are much less common than their epithelial counterparts, and thus cytologic experience on fine‐needle aspiration (FNA) is limited. FNA of lymphoid lesions with ancillary aids (flow cytometry and immunophenotypic studies) can make a definitive diagnosis. All FNAs of the parotid gland performed at the Johns Hopkins Hospital in an 8‐yr span (1990–1998) were reviewed retrospectively. In all, 391 cases were done, of which 76 cases of lymphoid lesions were identified. The relevant cytology, histology, and flow cytometry were analyzed. Of the 76 lymphoid lesions, results included reactive lesions (n = 35), lymphoepithelial cysts (n = 27), malignant lymphomas (n = 12), an atypical lymphoid population (n = 1), and Sjogrens disease (n = 1). We conclude that both reactive and malignant lymphoid lesions of the parotid can be diagnosed on FNA with adjunctive tests such as flow cytometry and immunophenotyping, obviating the need for surgery. Diagn. Cytopathol. 1999;21:170–173.

CD56 expression of neuroendocrine neoplasms on immunophenotyping by flow cytometry: a novel diagnostic approach to fine-needle aspiration biopsy.

CD56 antigen or NCAM (neural cell adhesion molecule) has an established role in the diagnosis of non‐Hodgkin lymphoma (NHL)‐natural killer cell type and other hematologic malignancies. Therefore, it is included routinely in the panel of antibodies for flow cytometric (FC) analysis of suspected lymphomatous tissue specimens obtained from fine‐needle aspiration biopsy (FNAB). The authors evaluated the role of CD56 expression on FC of neuroendocrine (NE) tumors. An initial diagnosis of NHL was suspected based on an on‐site FNAB evaluation.

Parotid fine-needle aspiration: A cytologic study of pediatric lesions

Fine‐needle aspiration (FNA) of parotid lesions in the pediatric age group presents interesting diagnostic problems. There is limited cytologic literature available on the subject. We studied the cytologic findings on FNA of parotid masses in seven such cases. Patients ranged in age from 1 to 17 years (mean = 10.4). Diagnoses included lymphoepithelial cyst (n = 1), mucoepidermoid carcinoma (n = 2), pilomatrixoma (n = 1), acinic‐cell carcinoma (n = 1), rhabdomyosarcoma (n = 1), and Ewings sarcoma (n = 1). Six cases were confirmed by subsequent histologic examination. The study elaborates on the cytologic features of each lesion and discusses the differential diagnosis of closely related entities peculiar to this age group. It highlights the role of FNA as the diagnostic modality of choice in dealing with pediatric parotid masses. Diagn. Cytopathol. 17:8–13, 1997.