Cyst fluid cytology of cerebellar hemangioblastoma: a case report.

Hemangioblastoma, an uncommon central nervous system neoplasm, commonly located in the cerebellum and more rarely in the spinal cord. In this report, we described the cytologic features of a cerebellar hemangioblastoma in a 53-year-old man, present in cystic fluid obtained at cranioctomy. Cytologic preparations were characterized by well preserved, scattered dissociate, and occasional groups of stromal cells with round to oval nuclei, fine chromatin, and lacelike or granular, vacuolated eosinophilic cytoplasm with a foamy appearances. In addition, calcific material, endothelial-like cells, blood, and macrophages were seen. The radiologic impression, cytologic features, and location led us to suggest the possibility of hemangioblastoma. Subsequent histopathological material revealed the characteristic features of hemangioblastoma.

Fine needle aspiration cytology of unsuspected metastatic hurthle cell carcinoma of the thyroid and its pitfalls: a report of two cases.

We discuss two cases of unsuspected metastatic thyroid carcinoma of Hurthle cell type, presenting as subcutaneous masses in the occipital scalp and supra-acetabular region of the right ilium; clinically suspected to be a lipoma and a vascular tumour, respectively. These two cases were initially investigated by fine-needle aspiration cytology. In case 1, a definitive diagnosis of metastatic Hurthle cell carcinoma was made based on cell block preparation and positive immunohistochemical stains for thyroglobulin and thyroid transcription factor-1. Case 2 was reported as suggesting an oncocytic process, metastatic Hurthle cell lesion. The filter preparations from both cases showed compact sheets and individual large polygonal cells with voluminous granular cytoplasm, eccentric nuclei with minimal atypia and bland chromatin. Scattered haemosiderin-laden macrophages and cystic debris were also identified in both cases. These cases are of interest as the bland cytologic features may lead to an erroneous benign diagnosis. Immunohistochemistry aids the definitive diagnosis of metastatic Hurthle cell carcinoma of thyroid especially when the presence of a previous thyroid lesion is not communicated to the laboratory.

Cytological findings in a sample of peritoneal aspirate from a case of bile peritonitis.

Bile peritonitis (BP) is a rare and serious condition warranting urgent surgical intervention to prevent the high incidence of mortality. BP is ascribed to the leakage of bile into the peritoneal cavity usually due to a perforation of the gallbladder or common bile duct caused by stones or a trauma. The radiological studies are useful in suggesting the diagnosis. The cytological findings of BP have been reported rarely in the literature characterised by the presence of lakes of stringy bile material admixed with variable numbers of histiocytes, mesothelial cells, and some inflammatory cells. Recently, we have examined an aspirate sample of peritoneal fluid (PF) obtained under ultrasound guidance in a case of BP ascribed to the perforation of the gallbladder in a 19-yr-old female patient in which apart from occasional bile pigment-laden macrophages admixed with a few mesothelial cells and inflammatory cells, numerous crystalline structures of varying shapes, sizes, and colour with birefringence along with some microspheroliths were found. At operation, the abdominal cavity showed a large amount of bile and the gallbladder specimen showed two perforations and gangrenous cholecystitis with numerous yellow-brown somewhat friable stones. The foregoing findings in the aspirate appeared to be of interest because to the best of our knowledge, numerous crystalline structures along with the cytological features of BP have not been described in the English literature.

Fine needle aspiration cytology of seromas of the breast from irradiated lumpectomy sites.

OBJECTIVE: To study the cytologic features of cells in breast aspirates of seromas in women who had undergone irradiation at lumpectomy sites. STUDY DESIGN: Cytologic material from 38 females with an age range of 39-72 years who had undergone aspiration of seromas were retrieved to determine tumor recurrence or other atypia. The material was obtained using the conventional method of needle aspiration with a 22-gauge needle and 10-mL syringe, maintaining negative pressure. The syringe and needle contents were washed in a cytology container containing 30% ethyl alcohol in physiologic saline. From half the washings filter preparations were made and stained by the Papanicolaou method, while from the other half cell blocks were made and sections cut after processing and stained with hematoxylineosin. RESULTS: In 2 of 38 patients, filter preparations and cell blocks showed malignant cells of breast carcinoma that were similar to the primary. This was confirmed on core biopsy and subsequent mastectomy. In 21 of 38 cases mildly atypical cells with degenerative effects, mild hyperchromasia, liberal cytoplasm, macrophages, inflammatory cells and a few apocrine cells were seen, while in 11 of 38 patients scanty debris, few inflammatory cells, rare apocrine cells and a few macrophages were found. In 4 of 38 cases highly atypical cells with hyperchromatic nuclei and nucleoli were noted. However, a core biopsy in all 4 patients revealed no evidence of residual tumor. CONCLUSION: Cell atypia in aspirates from seromas should be interpreted with caution to avoid unnecessary, invasive surgery, keeping in mind that radiation can cause misleading changes. However, patients with clinical indications of recurrent tumor or with severe atypia should undergo biopsy to permit appropriate management.

Diagnostic value of needle aspiration cytology in the assessment of palpable axillary lymph nodes. A study of 336 cases.

OBJECTIVE: To evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable axillary lymph nodes and determine whether ancillary procedures can be useful in enhancing the diagnosis. STUDY DESIGN: The material was analyzed in 336 cases with enlarged axillary lymph nodes in which NAC were performed by the conventional method. In all cases cytologic examination was done on site after staining the smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks, which showed the reliability of histologic architecture; further support was obtained with tissue biopsy and/or comparison with the primary tumor in some of the cases. RESULTS: Twelve cases were diagnosed as inflammatory lesions, and 64 were unsatisfactory due to scanty/acellular samples (despite 2-3 repeat samplings). However, in 6 of these, malignant tumors were later found on a biopsy done due to persistent and continued enlargement of an axillary lymph node or nodes. One hundred twenty-two cases were regarded as negative (normal cellular elements, n = 52; reactive elements, n = 70), and 4 cases were suspicious for malignancy. In 124 cases a variety of metastatic tumors were diagnosed (breast, n = 63; melanoma, n = 22; others, n = 39), and in 10 cases a diagnosis of lymphoma was made. CONCLUSION: NAC of palpable axillary lymph nodes as a first-line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on management. Also, histologic architecture from cell blocks can be correlated with cytology, and such material can be used for histochemical and immunomarker studies.

Value of image-guided needle aspiration cytology in the assessment of pelvic and retroperitoneal masses. A study of 112 cases.

OBJECTIVE: To evaluate the diagnostic value of the noninvasive method of image-guided needle aspiration cytology (NAC) in the assessment of radiologically detected pelvic and retroperitoneal space-occupying lesions (excluding the pancreas, kidney and adrenal). STUDY DESIGN: NAC was performed under computed tomographic or ultrasound guidance on 112 patients suspected of having a pelvic or retroperitoneal mass. Cytologic examination was performed on site after staining smears with the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks; further support was obtained with a tissue biopsy in some cases. Additionally, pertinent immunoperoxidase and/or histochemical studies were done. RESULTS: Eighteen cases were diagnosed as inflammatory lesions, 17 cases consisted of normal cellular elements, and 12 cases showed scanty material and were considered unsatisfactory/inadequate for a diagnosis. Five cases were suspicious for malignancy, and in 39 cases metastatic tumors were diagnosed from a previously known primary. Thirteen cases were diagnosed as lymphoma, and in 8 cases a diagnosis of soft tissue sarcoma was made. There were no false positive diagnoses of malignancy. Cell block preparations and immunohistochemistry were helpful with tumor typing, although lymphoma subtyping and soft tissue tumor typing generally required open biopsy. CONCLUSION: NAC, as the first-line investigation, is not only useful in the diagnosis of space-occupying lesions of the pelvic and retroperitoneal region but can also help in choosing appropriate management. The technique is most useful in diagnosing metastases but is also helpful in excluding malignancy in some cases and in suggesting diagnoses of lymphomas and soft tissue tumors.

Diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable inguinal lymph nodes: a study of 210 cases.

The aim of this study was to evaluate the diagnostic value of needle aspiration cytology (NAC) in the assessment of palpable inguinal lymph nodes, which were analyzed in 210 cases. NAC in all the cases were performed by the conventional aspiration method and cytologic examination was done on site after staining smears with the Papanicolaou method. In addition, Diff-Quik-stained air-dried smears, Papanicolaou-stained fixed smears, and filter preparations from needle washings and hematoxylin-eosin-stained sections of cell blocks were studied. The NAC diagnosis was supported by examining cell blocks in 92/210 cases which showed a reliable histologic architecture; further support was also obtained with a tissue biopsy in 9/12 cases of inflammatory lesions, 7/7 cases with a suspicious diagnosis, 20/26 cases of melanomas, 15/15 cases of lymphomas, and/or a comparison with the primary tumor in other cases of metastatic tumors. Additionally, immunoperoxidase and/or histochemical stains were done. Twelve cases were diagnosed as inflammatory lesions and 88 cases were regarded as negative (normal cellular elements n = 40; reactive elements n = 48). In 58 cases a variety of metastatic tumors were diagnosed (melanoma n = 26; others n = 32) and in 15 cases a diagnosis of lymphoma was made. Seven cases were diagnosed as suspicious of malignancy and 30 cases were unsatisfactory due to scanty/acellular samples (despite 2-3 repeat samplings). However, in five of these malignant tumors were later found on a biopsy which was done due to a persistent and continued enlargement of lymph node(s). The sensitivity was 91.7%, specificity 98.2%, positive predictive value (PPV) 97.7.%, and negative predictive value (NPV) was 95.45%. Based on our study we feel that NAC as a first line of investigation is not only useful in the diagnosis of lesions in inguinal lymph nodes, but can also help in deciding on an appropriate management. Also, histologic architecture from cell blocks can be correlated with cytology and such material can be used for histochemical and immunomarker studies.

Diagnostic value of image-guided needle aspiration cytology in the assessment of vertebral and intervertebral lesions.

The aim of this study was to evaluate the diagnostic value of the noninvasive method of image-guided needle aspiration cytology (NAC) in the assessment of radiologically detected vertebral and intervertebral space-occupying lesions. NAC was performed under computed tomographic (CT) guidance on 70 patients suspected of having a vertebral or intervertebral lesion. Cytologic examination was performed on site after staining smears with the Papanicoloau method. In addition, air-dried smears, fixed smears, filter preparations from needle washings, and cell blocks were studied. The NAC diagnosis was supported by examining cell blocks, which showed the reliability of histologic architecture; further support was obtained with a tissue biopsy in some cases. Additionally, immunoperoxidase and/or histochemical studies were done. Ten cases were diagnosed as inflammatory/degenerative lesions, and in 2 cases a diagnosis of neurofibroma was made. Twelve cases consisted of normal cellular elements, 7 cases were unsatisfactory/inadequate for diagnosis, and 4 cases were suspicious for malignancy. In 32 cases, a variety of metastatic tumors were diagnosed, while in 3 cases, a diagnosis of chordoma was made. Based on our study, we feel that NAC, as a first line of investigation, is not only useful in the diagnosis of space-occupying lesions of vertebral and intervertebral regions, but can also help in deciding on appropriate management. Also, histologic architecture from cell blocks can be correlated with cytology, and such material can be used for histochemical and immunomarker studies.

Aspiration cytodiagnosis of amyloid from vitreous fluid.

Amyloidosis of the vitreous body is a rare disorder that causes progressive visual loss. In this report, a 36-yr-old female with familial amyloidosis is described in whom a progressive reduction of vision in both eyes over the last 4 yr was ascribed to vitreous opacities due to amyloid. A left pars plana vitrectomy was performed and an aspirated sample of the vitreous on cytologic examination showed vitreous strands admixed with abundant dense, pink, globular material which was intensely positive on Congo red staining and exhibited yellowish-green birefringence indicative of amyloid. This was further confirmed ultrastructurally, which showed the classical appearance of amyloid fibrils. The case is of interest not only in view of the rarity of the condition but also in view of the fact that as far as we are aware the cytodiagnosis of amyloid from an aspirate sample from the vitreous has not been previously described in the literature.