Diagnostic terminology for reporting thyroid fine needle aspiration cytology: European Federation of Cytology Societies thyroid working party symposium, Lisbon 2009.

A European Federation of Cytology Societies (EFCS) working party of 28 members from 14 European countries met at the European Congress of Cytology in Lisbon in September 2009, with two observers from the USA, to discuss the need for standardising thyroid FNA nomenclature in the light of the National Institute of Cancer (NCI) recommendations resulting from the State of the Science conference in Bethesda in 2007. The data were obtained through two questionnaires sent by email and a transcript of the live discussion at the congress, which is presented in full. The surveys and discussion showed that there were currently no national terminologies for reporting thyroid FNA in the different European countries except in Italy and the UK. Personal, 'local', surgical pathology and descriptive terminologies were in use. All but one of the working party members agreed that thyroid FNA reporting should be standardised. Whilst almost a third would adopt the NCI Bethesda terminology, which offers the advantages of a 'risk of cancer' correlation and is linked to clinical recommendations, more than half favoured a translation of local terminology as the first step towards a unified nomenclature, as has been done recently in the UK. There was some disagreement about the use of: a) the six-tiered as opposed to four or five-tiered systems, b) the use of an indeterminate category and c) the 'follicular neoplasm' category, which was felt by some participants not to be different from the 'suspicious of malignancy' category. The conclusions will be passed to the different national societies of cytology for discussion, who will be asked to map their local terminologies to the Bethesda classification, observe its acceptance by clinicians and audit its correlation with outcome.

Aspiration biopsy of pleomorphic lipoma of the breast. A case report.

BACKGROUND: It is well known that subcutaneous lumps in the breast may create diagnostic confusion. We report, for the first time in the cytologic literature, the features of a pleomorphic lipoma in the breast. CASE: Pleomorphic lipoma of the breast was aspirated, showing typical floret cells and mononuclear, hyperchromatic cells with scalloped nuclei, masquerading as malignancy. CONCLUSION: Pleomorphic lipoma has rather typical cytologic features that may allow its recognition when they are present in the proper clinical setting. This report illustrates another diagnostic pitfall in fine needle aspiration biopsy of the breast.

Liesegang rings in a dermoid cyst of the floor of the mouth. Report of a case with cytologic findings.

BACKGROUND: Eosinophilic, ring-shaped structures, referred to as Liesegang rings (LRs), have been identified in aspirates from many organs, usually in relation to cystic or inflammatory lesions, but never before in relation to a dermoid cyst. CASE: LRs were intermingled with squamous cells in aspirates from a cyst of the floor of the mouth. The patient, a 23-year-old man, presented with a sublingual mass that had recently grown. Histopathologic study showed a ruptured dermoid cyst with mural foci of granulomatous foreign body reaction mixed with numerous ringlike structures, LRs. CONCLUSION: To the best of our knowledge, this is the first reported case of LRs in a dermoid cyst. Pathologists should be aware of this association when diagnosing cystic lesions.

Granulomatous reaction to silicone in axillary lymph nodes. A case report with cytologic findings.

BACKGROUND: Silicone lymphadenopathy is a rare complication in patients with breast implants and is often confused with metastases from breast carcinoma. CASE: A 36-year-old female who had undergone bilateral breast augmentation six years earlier was referred for a mass in the left axilla. Fine needle aspiration showed a granulomatous reaction to birefringent material with predominance of foreign body giant cells in a lymphoid background. CONCLUSION: This report illustrates the usefulness of fine needle aspiration in axillary nodes of patients with breast implants in ruling out malignancy and diagnosing implant disruption.

Lymphoepithelial cyst with crystalloid formation. Cytologic features of two cases.

BACKGROUND: The presence of amylase crystalloids (AC) in cystic lesions of the parotid gland is a rare occurrence and has been diagnosed to date as sialadenitis. We report the first two cases of parotid lymphoepithelial cyst (LC) containing this type of crystalloid. CASES: Case 1, a 56-year-old male, presented with a 3-cm parotid cyst. Fine needle aspiration (FNA) was performed on the mass. Smears showed numerous crystalloids identical to those described as crystallized amylase. Case 2, a 36-year-old female, had a 2-cm parotid mass. FNA smears exhibited the same features as did case 1. The two patients were treated with superficial parotidectomy, and an LC containing AC was diagnosed in both cases. CONCLUSION: When the above findings are present on FNA of parotid gland, the diagnosis of LC must be considered.

Breast carcinoma in situ in a male. Report of a case diagnosed by nipple discharge cytology.

BACKGROUND: Cytologic evaluation of abnormal nipple secretion is a well-established method for the rapid diagnosis of breast carcinoma in females. However, less attention has been focused on male patients presenting with nipple discharge. CASE: A case of intraductal carcinoma of the male breast was diagnosed by nipple discharge cytology alone. CONCLUSION: This report illustrates the usefulness of nipple discharge cytology in the diagnosis of early breast carcinoma in males.

Metastatic squamous cell carcinoma in a liver graft. Report of a case diagnosed by fine needle aspiration.

BACKGROUND: Fine needle aspiration is a well-established and safe method for the diagnosis of focal liver lesions, but it has played a limited role in the transplant setting. CASE: A case of metastatic squamous cell carcinoma in a liver graft was diagnosed by fine needle aspiration. The tumor developed in the right pyriform sinus five years after an orthotopic liver transplantation was performed. CONCLUSION: With the improvement of survival rates following liver transplantation, metastatic tumors should be considered in liver grafts with space-occupying lesions. Therefore, fine needle aspiration is adequate for diagnosis and is cost-effective and safe.

Subareolar abscess of the breast in a male. A report of two cases with fine needle aspiration cytology diagnosis.

BACKGROUND: Fine needle aspiration (FNA) is a well-established method for the diagnosis of breast diseases in males, but very little attention has been focused on inflammatory lesions. Previous reports do not mention subareolar abscess (SA), which is a distinct entity in breasts of females. CASES: Two adult males presented for FNA of recurrent breast masses located near the nipple. Smears from both patients showed the typical cytologic features of SA. CONCLUSION: Recognition of this troublesome and rare condition on FNA cytology from the breasts in males will prevent recurrences since SA is not cured by excisional biopsy.

Primary cardiac hydatid cyst in a child. Cytologic diagnosis of a case.

BACKGROUND: Echinococcosis is a troublesome disease, particularly common in sheep-raising communities and usually caused by the cestode Echinococcus granulosus. Although it has been found in almost every organ, isolated cardiac disease is an exceptional presentation since cardiac involvement occurs in only 0.5-3% of echinococcosis cases. CASE: A case of primary cardiac hydatid cyst occurred in a 4-year-old male. The asymptomatic patient was admitted to the hospital for evaluation of an intracardiac cyst. The lesion was successfully excised by open heart surgery, and a definitive diagnosis was made postoperatively by Giemsa staining of hooklets and scolices in cyst fluid. CONCLUSION: This case is of special interest because of the rare site of the lesion and young age of the patient. Pathologists should be alert to the possibility of this parasite appearing in unusual clinical settings.

Fine needle aspiration diagnosis of carcinoma arising in an ectopic breast. A case report.

BACKGROUND: Ectopic breast tissue has been found at many anatomic locations. Neoplastic and hyperplastic lesions similar to those that develop in the normal breast can occur in supernumerary ones. CASE: A 45-year-old female presented with a 30-cm, firm, subcutaneous mass in the left side of the chest wall that was clinically considered an ectopic breast. Fine needle aspiration biopsy showed irregular clusters and single epithelial cells with marked atypia, pleomorphism and occasional magenta bodies. CONCLUSION: This case illustrates that fine needle aspiration biopsy is a rapid and highly specific technique that can be used as the first diagnostic step in cases of carcinoma arising in an ectopic breast.

Ultrastructural diagnosis of facial nerve schwannoma using fine needle aspiration.

In a 14-year-old boy presenting with left facial nerve paralysis, physical examination revealed a soft, round mass in the floor of the left external auditory canal. A fine needle aspiration biopsy was performed to obtain material for light and electron microscopy. Several small groups of uniform, spindle-shaped neoplastic cells were present on the slides; a malignant mesenchymal tumor was considered, but a definite diagnosis could not be established under light microscopy. The ultrastructural examination revealed spindle-shaped and stellate cells with multiple parallel cytoplasmic processes lined with a well-developed basal lamina; these features are highly characteristic of a benign schwannoma.

Primary adenocarcinoma of the vagina. A case report with light and electron microscopic study.

A case of primary adenocarcinoma of the vagina in a 46 year old woman is reported. The light and electron microscopic studies are highly suggestive of a Müllerian origin. The ultrastructural features are discussed in relation to clear cell adenocarcinoma of the vagina, establishing the differences between them.