Atypical hemangioma of the breast: a diagnostic pitfall in breast fine-needle aspiration.

We report on the fine-needle aspiration (FNA) cytology of atypical hemangioma of the breast in a 52-yr-old female. The patient presented with a 2-cm palpable left breast mass. An FNA of the mass was performed following a mammogram, corresponding to the palpable breast mass. The FNA demonstrated the presence of numerous atypical single spindle cells scattered throughout a hemorrhagic background. An unequivocal diagnosis of malignancy was not rendered in this case. However, the degree of cytologic atypia suggested a malignant process, and a recommendation for an excisional biopsy was made. Atypical hemangioma should therefore be included in the differential diagnosis of angiosarcoma and other benign and malignant spindle-cell lesions of the breast encountered on cytologic samples.

Intraoperative scrape cytology: comparison with frozen sections, using receiver operating characteristic (ROC) curve.

The diagnostic role of intraoperative cytology (IC) has been demonstrated by many comparative studies. These studies have used sensitivity and specificity as statistical tools, based on binary principles. Statistical methods based on binary principles appear to be inappropriate for comparing anatomic pathology studies which involve significant human judgment with a range of subjective nonbinary result patterns. In this study, we applied the receiver operating characteristic (ROC) curve, which is based on probabilistic principles for the comparison of diagnostic accuracy with IC and frozen sections (FS). Seven observers studied a variable number of IC alone, FS alone, and IC/FS together from a pool of 446 specimens. The results were analyzed by ROC curve, using the MEDCALC software program (MedCalc Software, Mariakerke, Belgium). The accuracy with IC alone and FS alone was comparable. IC alone was diagnostic for many lesions, offering the choice of not freezing the tissue, and thus avoiding the introduction of artifacts. This strongly favors the routine practice of preparing IC during intraoperative consultation.

Fine-needle aspiration biopsy in the evaluation of lymphadenopathy associated with cutaneous T-cell lymphoma (mycosis fungoides/Sézary syndrome).

We studied the role of fine-needle aspiration (FNA) in the evaluation of lymphadenopathy associated with cutaneous T-cell lymphoma (CTCL) in 11 patients with lymphadenopathy and compared findings with corresponding histologic material. Molecular genetic analysis for T-cell clonality by polymerase chain reaction (PCR) was performed on all aspirates. Immunophenotyping was successful in 4 of 7 cases in which flow cytometry was attempted from the aspirated material. Cytologic evaluation of FNA samples correlated strongly with histologic rating of involvement based on numbers of atypical cerebriform lymphocytes in the nodal specimen. Of 7 nodal specimens with scattered or small groups of atypical cells in the background of dermatopathic lymphadenopathy (LN1-2), the cytologic diagnosis was interpreted as reactive in all instances. Of 4 specimens with highly suspect (LN3) or definite histologic involvement (LN4), the cytologic diagnosis was likewise suspect or malignant. The correlation between molecular genetic studies on FNA samples and studies on tissue was not significant; in 2 cases, a T-cell clone was detected in the nodal tissue sample but not in the FNA sample, suggesting undersampling. A T-cell clone was detected by PCR in 5 of 7 nodal specimens judged reactive by FNA biopsy or histologic assessment. FNA for cytologic and molecular genetic analysis is a useful method to evaluate lymphadenopathy associated with CTCL and may obviate the need for surgical biopsy.

Mucin stain on frozen sections: a rapid 3-minute method.

CONTEXT: The importance of frozen-section diagnoses in the practice of pathology cannot be overemphasized. In some cases, the use of a mucin stain can greatly aid in the diagnosis. Since few methods for mucin staining have been described that can be used in the frozen-section setting, we developed one such staining procedure for mucin. OBJECTIVE: To develop a rapid mucicarmine staining technique to be used on frozen sections that does not significantly delay overall turnaround time. DESIGN: A standard mucicarmine staining technique was modified by using a concentrated mucicarmine stain and a microwave oven, to reduce the total staining time to 3 minutes or less. Frozen tissue from normal colonic mucosa was used as a control, and skin from extramammary Paget disease for evaluation of margins was used as a case. RESULTS: The rapid mucicarmine stain successfully demonstrated the presence of mucin on frozen-tissue sections. Mucin stained deep rose, and the connective tissue stained green. CONCLUSION: This rapid and simple mucin staining technique can be used on frozen sections with no significant effect on the overall turnaround time, thereby aiding rapid diagnosis on frozen sections.

Malignant phyllodes tumor with chondrosarcomatous differentiation: report of a case with cytological presentation.

Malignant phyllodes tumor is a rare breast tumor with neoplastic epithelial and stromal components. The stromal component may show homologous and heterologous sarcomatous elements, including chondrosarcomatous and osteosarcomatous differentiation. Because these tumors may present with an almost exclusively sarcomatous component, it is important for the pathologist to include this entity in the diagnostic considerations of fine-needle aspirations of breast neoplasms showing sarcomatous differentiation. Following surgical excision, careful examination of the gross specimen and thorough sampling of the specimen is recommended before rendering a definitive histologic diagnosis. We describe the cytologic and histologic findings in a case of malignant phyllodes tumor with sarcomatous overgrowth showing predominantly chondrosarcomatous differentiation.

Pheochromocytoma. Cytologic findings on intraoperative scrape smears in five cases.

BACKGROUND: There have been few studies describing the cytology of adrenal pheochromocytoma (PC). Although fine needle aspiration (FNA) for a preoperative diagnosis of PC is generally considered a contraindication, this tumor can be an unsuspected finding in adrenal FNA performed for other reasons. STUDY DESIGN: Scrape cytology smears prepared in five cases of PC were examined for different cytomorphologic features. The results were correlated with the corresponding permanent histologic sections. RESULTS: Previously described features, like cellular smears showing cells with abundant, poorly defined fragile cytoplasm, bare nuclei, anisonucleosis, "salt and pepper" chromatin, variable nucleoli and few ganglion cell-like cells, were noted. In addition, several previously unreported cytologic features were observed: (1) loosely cohesive PC cells along a ramifying, delicate central core; (2) intracytoplasmic microvesicular (not hyaline/homogeneous) globules; and (3) different arrangements of capillary-stroma and PC cells (Zellballen pattern; empty capillary rings; stroma with adherent, intact PC cells or fragments of disrupted PC cell cytoplasm). CONCLUSION: The cytologic appearance of PC may resemble that of other neuroendocrine tumors; however, it can be diagnostic when combined with proper clinical data and ancillary tests.

Breast abnormalities in patients with cystic fibrosis: previously unrecognized changes.

We reviewed breast tissue from 19 female postpubertal and three prepubertal patients with cystic fibrosis to determine the histopathologic changes present. Autopsy material was available from 19 patients who died from complications of cystic fibrosis. Two patients had lumpectomies for breast carcinoma and an additional patient had a breast biopsy and bilateral prophylactic mastectomies for breast carcinoma. The postpubertal patients ranged in age from 18 to 50 years (median age, 32 years). The histologic changes in the breast of female patients with cystic fibrosis have not been fully studied, and the only case reported suggests that these patients suffered from complete lobular agenesis. This study shows that postpubertal breasts had normal development and varying degrees of fibrosis affecting lobular units and ducts, and that proliferative lesions and carcinoma could be encountered.

Focal hematopoietic hyperplasia of the rib. Report of a case diagnosed by fine needle aspiration.

BACKGROUND: Focal hematopoietic hyperplasia (FHH) of the rib is a rare, benign, localized proliferation of bone marrow to such a degree that it produces a tumorlike expansion of the rib that can be the source of considerable clinical alarm. In the appropriate clinical setting, this lesion needs to be included in the differential diagnosis of solitary bone lesions, in particular when assessing the adequacy of a specimen at the time of aspiration. CASE: A large, lytic mass on the posterior aspect of the sixth rib was incidentally discovered on a chest roentgenogram from a 46-year-old male during a routine presurgical evaluation for diverticulitis. The radiologic characteristics of the tumor were thought to be consistent with a neoplasm; that prompted a recommendation for fine needle aspiration biopsy (FNAB). The mass was thoroughly sampled under radiologic guidance, performing multiple aspirations of different areas. All smears prepared at the time of the aspiration for the evaluation of specimen adequacy showed abundant marrow tissue without any evidence of malignancy. Although it was initially thought that the tissue was probably obtained from the periphery of the lesion, this notion was discarded after multiple passes from different areas showed only marrow tissue and since there was radiologic evidence that the sample was obtained from within the lesion. CONCLUSION: The diagnosis of FHH of the rib by FNAB or other small-biopsy techniques requires strict radiologic-pathologic correlation. Awareness of this entity will avoid unnecessary repeated biopsy procedures and potentially large, complicated surgical procedures. This case shares several features with the other two reported cases: a solitary lesion on the rib presenting in an asymptomatic patient with no evidence of associated hematologic disease.

Small noncleaved cell lymphoma presenting as a massive pericardial effusion. A case report.

BACKGROUND: Non-Hodgkin's lymphoma (NHL) is commonly associated with cardiac involvement, especially in cases of advanced stages with mediastinal involvement. Much rarer is the initial presentation of NHL as a pericardial effusion; there are only 12 cases reported. In addition, only 5 of these 12 cases were correctly diagnosed based on examination of pericardial fluid prior to death: 3 were based on routine cytology; 1 on immunoperoxidase staining and 1 on an immunofluorescent slide method. CASE: A 71-year-old, white female presented with a massive pericardial effusion. Small noncleaved cell lymphoma was expeditiously diagnosed by cytologic examination combined with flow cytometric immunophenotyping. No further diagnostic tissue was obtained; the patient was staged and offered treatment with a protocol for high grade lymphoma. CONCLUSION: Combining cytomorphology and flow cytometric immunophenotyping in such cases results in an expeditious, nonsurgical diagnosis, upon which therapeutic decision making may be based.

Cytologic findings in a case of T-cell rich B-cell lymphoma: potential diagnostic pitfall in FNA of lymph nodes.

Fine-needle aspiration biopsy (FNAB) is a reliable diagnostic technique for most palpable masses. This technique is utilized routinely to diagnose metastatic carcinoma and melanomas in lymph nodes. However, the role of FNAB in the investigation of lymphoproliferative lesions is still controversial. Recent publications have supported the use of FNAB cytology, in conjunction with immunophenotyping, as an accurate, reliable diagnostic modality for the classification of most lymphomas (Sneige et al., Acta Cytol 1990; 34:311-322; Skoog and Tani, Diagn Oncol 1991; 1:12-18; Robins et al., Am J Clin Pathol 1994; 101:569-576; Katz, Clin Lab Med 1991; 11:469-499). We present a case of a T-cell rich, large B-cell lymphoma. Material obtained by FNAB mimicked a reactive process by both cytomorphological and immunophenotypical analysis. This case demonstrates a potential pitfall in the use of FNAB to evaluate lymphoproliferative disorders even when used in conjunction with immunophenotypic studies. The case also emphasizes the need for detailed clinical and prior pathologic information when a cytologic sample is being evaluated for a lymphoproliferative disorder. To our knowledge, the cytomorphologic findings of this particular type of lymphoma have not been previously described as seen on an FNAB.

Multiple myeloma with monoclonal surface immunoglobulin expression: a case report.

BACKGROUND: Plasma cells from patients with multiple myeloma have been found to express the immunophenotype of normal plasma cells without surface immunoglobulin expression. CASE: A case occurred of multiple myeloma with monoclonal surface immunoglobulin expression, defined by morphology and flow cytometric immunophenotyping of a fine needle aspiration biopsy of an osteolytic rib lesion and a bone marrow aspirate as well as urine and serum protein electrophoresis with immunofixation. CONCLUSION: The clinical significance of monoclonal surface immunoglobulin expression in rare cases of multiple myeloma is uncertain, and other parameters with clinical significance (CD10 positivity, multiple myeloid antigen expression) will continue to be more useful until additional cases accrue.

Benign cystic lymphoepithelial lesion of the parotid gland an unusual presentation of the acquired immunodeficiency syndrome.

This article presents a case of a young, otherwise asymptomatic male patient with a parotid gland enlargement. The initial clinical history did not reveal any risk factors related with HIV infection. A fine needle aspiration biopsy of the lesion showed a benign cystic lymphoepithelial lesion of the parotid gland. This once unusual lesion of the salivary gland has been recently associated with infection by the human immunodeficiency virus (HIV) and is presently encountered with increased frequency in the clinical practice. The knowledge of the association between these two entities led, in this case, to the diagnosis of HIV infection in an otherwise asymptomatic patient. Early detection of HIV infection is of vital importance since it has been demonstrated that prompt treatment of these patients with AZT slows down the progression of the disease.

Fine needle aspiration biopsy in the management of patients with deep seated metastatic and recurrent malignancies.

Fine needle aspiration (F.N.A.) is widely accepted as a safe and reliable diagnostic technique. In patients presenting with widespread metastatic disease of unknown primary origin it can play an important role in providing a rapid and accurate diagnosis and therefore allowing to institute a prompt therapeutic approach. This technique can usually be performed in an outpatient setting needing no hospitalization therefore reducing the cost both for the hospital and for the patient. When a definitive diagnosis is reached with the use of F.N.A. the patient can be spared from unnecessary surgery. A few examples are presented of patients with widespread metastatic disease in which a definitive diagnosis was reached through the use of F.N.A.

Diagnosis of an unusual abdominal presentation of granuloma inguinale by fine needle aspiration cytology.

A 63-year-old Hispanic man from Peru who recently had immigrated to the United States presented with progressive weakness, weight loss, recurrent abdominal pain and passing bright red blood per rectum. Rectal carcinoma was suspected. Biopsies of two lesions in the sigmoid colon showed granuloma inguinale (donovanosis). A computed tomographic scan of the abdomen revealed a large presacral mass. A radiographically guided fine needle aspiration (FNA) of the presacral mass showed findings characteristic of granuloma inguinale. FNA thus proved to be a useful adjuvant in the diagnosis of an unusual case of granuloma inguinale (donovanosis) presenting with a presacral mass that had the radiologic characteristics of a malignant tumor.