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To evaluate the quality of fine needle aspiration cytology diagnosis on malignant salivary gland neoplasms, cytologic findings were correlated with histologic diagnosis of 56 surgically removed malignant salivary gland tumors. Seven cases (12.5%) were insufficient, 23 cases (41.1%) were diagnosed as malignant, 17 (30.4%) cases were accurately diagnosed by histologic subtype, and 9 cases (16%) were diagnosed as benign. Five out of 9 false negative cases were misdiagnosed as pleomorphic adenomas. Except the cases with insufficient specimen, overall sensitivity was 81.6%, and the sensitivity varied according to the histologic subtype; 91% in salivary duct carcinoma, 100% in carcinoma ex pleomorphic adenoma, 50% in mucoepidermoid carcinoma, 63% in adenoid cystic carcinoma, and 50% in acinic cell carcinoma. The diagnostic accuracy differed among cytopathologists irrespective of periods after acquisition of board of pathologists. These results confirm that salivary gland neoplasm can be easily misdiagnosed in fine needle aspiration cytology and a great caution should be given in diagnosing the benign appearing salivary aspirates to avoid under-diagnosis of malignant neoplasm with low grade cytologic atypia.
Ancient (degenerated) schwannomas are benign tumors that display pronounced degenerative changes including cyst formation, calcification, hemorrhage, and hyalinization. The tumors are usually infiltrated by large numbers of inflammatory cells such as neutrophils, lymphocytes, siderophages, and histiocytes. They are located in deep locations such as the retroperitoneum and must be differentiated from malignant soft tissue tumors because spindle cells with nuclear atypia may be present. In the fine needle aspiration biopsy. The cytologic findings of two cases of ancient schwannoma occurring in posterior mediastinum and retroperitoneum, respectively, are described. Computerized tomographic findings of both cases showed changes of cystic degeneration or necrosis. A case occurred in retroperitoneum revealed features of destruction of vertebral body to suggest a malignant soft tussue tumor radiologically. The cytologic findings of aspiration biopsy of both tumors revealed that the tumor cells were spindle in shape with elongated nuclei. Some of tumor cells were arranged in a palisading fashion. Cell structures that resemble the Verocay bodies were observed. Some of the tumor cells showed pleomorphic bizarre nuclei, but no mitotic activity or chromatin clumping was seen. Inflammatory cells, siderophages and histiocytes were scattered in fibrillar material. These cytologic findings are important in the diagnosis of ancient schwannoma and in the differentiation of this tumor from the malignant spindle cell tumor.
Carcinsarcoma is an uncommon pulmonary malignancy characterized by carcinmatous parenchyma and sarcomatous stroma. The cytologic, immunohistochemical and ultrastructural features of a case of pulmonary carcinosarcoma suspected by fine needle aspiration cytology is presented. Only bizarre spindle cells arranged in loose groups, in microtissue fragments and in a dissociate fashion were present on the aspiration smears. They were markedly positive for vimentin. The epithelial component was not found, which was probably due to marked paucity of carcinomatous component that was proved by histologic examination of the resected tumor. The diagnosis of pulmonary carcinosarcoma should be conidered whenever poorly differentiated epithelial ceil groups with a malignant mesenchymal component set in a myxoid background are seen in a pulmonary cytology specimen.
The mucoepidermoid carcinoma is a rare tumor in the lung. A case of bronchial mucoepidermoid carcinoma diagnosed by fine needle aspiration cytology is presented. The smear showed many intermediate cells with occasional mucus-secreting cells. Malignant squamous cells were not present. The cellular arrangement of intermediate cells was overlapping and grouped in ball-like fashion. These cytologic features are unique for diagnosis of this tumor.
A case of metastatic adenoid cystic carcinoma of the lung, originated from the trachea, was diagnosed by fine needle aspiration. Although the cytologic features of adenoid cystic carcinoma have been well described, it is easy to confuse adenoid cystic carcinoma with more common primary small cell neoplasms of the lung, i.e., small cell carcinoma, well differentiated adenocarcinoma, and carcinoid tumor of the lung. The features distinguishing adenoid cystic carcinoma from these neoplasms include 1) tight, globular, honeycomb pattern of cells, 2) acellualr basement membrane material in the lumen, and 3) cells lacking true nuclear melding and having bland chromatin pattern. The morphologic feature of metastatic adenoid cystic carcinoma in this case was so distinctive as to permit a definite diagnosis by aspiration cytology.
Bone metastasis of hepatocellular carcinoma appears to be peculiar when clinical manifestation of liver disease is not apparent, and initial diagnosis of metastatic hepatocellular carcinoma by fine needle aspiration cytology is rarely obtained. We experienced a case of 45-year-old man with metastatic hepatocellular carcinoma in the sacrum, which was diagnosed by fine needle aspiration cytology. The intrahepatic mass, measuring 1.2 cm in diameter and kept unchanged in size for two years, was never proved to be hepatocellular carcinoma histopathologically. The aspirated neoplastic cells were mostly in sheets, showing abundant acidophilic cytoplasm and large, round, centrally located nuclei with single, prominent acidophilic mucleoli. In the cell block section, diagnosis of metastatic well-differentiated hepatocellular carcinoma was made without difficulty, and definite trabecular fashion with sinusoidal endothelial cell lining was found.
The cytologic findings in fine needle aspiration of a case of myxoid liposarcoma of the mediastinum are described. The smear and cell block of the aspirate revealed solid clusters with background of amorphous material and scattered single tumor cells. The clusters were moderately cellular and consisted of atypical lipoblasts in varying stages of differentiation and delicate plexiform capillaries. Good correlation was found between the histologic and cytologic findings in the fine needle aspirates. The differential diagnosis between myxoid liposarcoma and other myxoid soft tissue tumors is discussed.
A total of 362 bile samples from 104 patients with evidence of biliary tract obstruction were submitted for diagnostic cytology from January, 1989 to April, 1991. The patients were classified based on the obstructive cause, and the cytologic results were reviewed. 298 of the specimens were from patients with intrabiliary malignant structure, and 17 were from patients with extrabiliary malignant compression or benign biliary obstruction. Bile cytology was positive for carcinoma in 42 samples from patients with intrabiliary malignant stricture, and the diagnostic sensitivity was 14%. There were no false positive cases. We concluded that the cause of low sensitivity was degenerative change of cell due to prolonged sampling time. What is noteworthy was the high prevalence of Clonorchis sinensis eggs, being detected in 25 patients with intrabiliary malignancy, supporting the association between clonorchiasis and biliary tree malignancy.
Metastatic tumors occur more frequently in the liver than in any other organ. Guided percutaneous fine-needle aspiration (FNA) of the liver is often recommended for confirmative diagnosis of the metastatic lesion, because of its simplicity, high yield, and reasonable safety. The authors studied retrospectively cytologic findings of 110 cases of metastatic tumors to the liver. The frequent primary sites were the stomach (23 cases), pancreas(19 cases), gallbladder(12 cases), and periampullary lesions(6 cases). Most of the metastases were carcinoma (106 cases). There were only 4 cases of sarcoma. The characteristic cytologic findings of FNA of meatastatic tumors were dirty background, abrupt change between hepatocytes and malignant cells, and desmoplasia. Some tumors displayed rather distinctive cytologic appearance that suggests primary sites. For example, the colonic adenocarcinoma showed tall columnar cells with a palisading arrangement, adenocarcinoma of gallbaldder showed focal squamous differentiation in some cases, and metastatic renal cell carcinoma and neuroblastoma showed also distinctive cytologic findings. Because the cytologic features of metastatic tumor are very similar to those of primary tumor, correct cytologic typing may be helpful in pursuit of an occult primary site of metastatic liver lesions, reducing extensive diagnostic investigation in poor prognostic patients.
Liver is generally known as an organ which is most commonly involved by the metastic tumors. According to the tendency of using fine needle aspiration in the diagnosis of hepatic tumors, the differentital diagnosis between hepatocellular carcinoma and metastatic carcinoma frequently has been a main issue in the poorly differentitated cases, especially to the pathologists of Korea, an endemic area of hepatocellular carcinoma. Until now the problem has been usually solved by the comparison of cytologic characteristics of their tumor cells but not by background cytologic features which rarely have been studied. We observed the background cytologic features helpful for the differential diagnosis through the analysis of 20 cases who had confirmed primary cancer and were diagnosed as metastatic carcinomas in the liver by fine needle aspiration cytology. Twenty cases included 9 adenocarcinomas, 7 spuamous cell carcinomas, 1 small cell carcinoma, 1 carcinoid, 1 adenoid cystic carcinoma, and 1 renal cell cacinoma. Analysis of background cytologic features revealed that 77% of adenocacinoma cases showed benign mesenchymal components and hepatocytes and spuamous cell carcinoma cases disclosed benign mesenchymal tissue (71%) and necrosis (57%), Remaining cases showed variable combinations of benign mesenchymal component, necrosis, hepatocytes, and bile duct epithelial cells. No case revealed atypical hepatocytic naked nuclei, a useful cytologic finding of hepatocellular carcinoma. In summary, the background cytologic features more commonly observed in metastatic carcinomas than in the hepatocellular carcinoma were benign mesenchymal components, hepatocytes, necrosis, and bile duct epithelium. The endothelial cells and hepatocytic naked nuclei, two relatively specific findings of hepatocellular carcinoma were not observed except for renal ceil carcinoma. Above background cytologic features are thought to be helpful for the differential diagnosis between the hepatocellular carcinoma and various metastatic carcinomas in the poorly differentiated cases.