ABSTRACT
It is critical to identify biomarkers and functional networks associated with aggressive thyroid cancer to anticipate disease progression and facilitate personalized patient management. We performed miRNome sequencing of 46 thyroid tumors enriched with advanced disease patients with a median follow-up of 96 months. MiRNome profiles correlated with tumor-specific histopathological and molecular features, such as stromal cell infiltration and tumor driver mutation. Differential expression analysis revealed a consistent hsa-miR-139-5p downexpression in primary carcinomas from patients with recurrent/metastatic disease compared to disease-free patients, sustained in paired local metastases and validated in publicly available thyroid cancer series. Exogenous expression of hsa-miR-139-5p significantly reduced migration and proliferation of anaplastic thyroid cancer cells. Proteomic analysis indicated RICTOR, SMAD2/3 and HNRNPF as putative hsa-miR-139-5p targets in our cell system. Abundance of HNRNPF mRNA, encoding an alternative splicing factor involved in cryptic exon inclusion/exclusion, inversely correlated with hsa-miR-139-5p expression in human tumors. RNA sequencing analysis revealed 174 splicing events differentially regulated upon HNRNPF repression in our cell system, affecting genes involved in RTK/RAS/MAPK and PI3K/AKT/MTOR signaling cascades among others. These results point at the hsa-miR-139-5p/HNRNPF axis as a novel regulatory mechanism associated with the modulation of major thyroid cancer signaling pathways and tumor virulence.
Subject(s)
Biomarkers, Tumor/metabolism , Gene Expression Regulation, Neoplastic , Heterogeneous-Nuclear Ribonucleoprotein Group F-H/genetics , MicroRNAs/metabolism , Thyroid Neoplasms/genetics , Adult , Aged , Aged, 80 and over , Alternative Splicing/genetics , Cell Line, Tumor , Cell Proliferation/genetics , Disease-Free Survival , Female , Follow-Up Studies , Gene Expression Profiling , Heterogeneous-Nuclear Ribonucleoprotein Group F-H/metabolism , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Prognosis , Signal Transduction/genetics , Survival Rate , Thyroid Gland/pathology , Thyroid Neoplasms/mortality , Thyroid Neoplasms/pathologyABSTRACT
Disruption of the Krebs cycle is a hallmark of cancer. IDH1 and IDH2 mutations are found in many neoplasms, and germline alterations in SDH genes and FH predispose to pheochromocytoma/paraganglioma and other cancers. We describe a paraganglioma family carrying a germline mutation in MDH2, which encodes a Krebs cycle enzyme. Whole-exome sequencing was applied to tumor DNA obtained from a man age 55 years diagnosed with multiple malignant paragangliomas. Data were analyzed with the two-sided Student's t and Mann-Whitney U tests with Bonferroni correction for multiple comparisons. Between six- and 14-fold lower levels of MDH2 expression were observed in MDH2-mutated tumors compared with control patients. Knockdown (KD) of MDH2 in HeLa cells by shRNA triggered the accumulation of both malate (mean ± SD: wild-type [WT] = 1±0.18; KD = 2.24±0.17, P = .043) and fumarate (WT = 1±0.06; KD = 2.6±0.25, P = .033), which was reversed by transient introduction of WT MDH2 cDNA. Segregation of the mutation with disease and absence of MDH2 in mutated tumors revealed MDH2 as a novel pheochromocytoma/paraganglioma susceptibility gene.
Subject(s)
DNA, Neoplasm/analysis , Exome , Germ-Line Mutation , Malate Dehydrogenase/genetics , Paraganglioma/genetics , Paraganglioma/metabolism , Citric Acid Cycle , Down-Regulation , Fumarates/metabolism , Gene Expression Regulation, Enzymologic , Gene Expression Regulation, Neoplastic , Genetic Predisposition to Disease , HeLa Cells , Humans , Malate Dehydrogenase/metabolism , Malates/metabolism , Male , Middle Aged , Pheochromocytoma/genetics , Pheochromocytoma/metabolism , Sequence Analysis, DNAABSTRACT
El objetivo de este artículo es presentar un caso infrecuente de adenoma folicular de tiroides productor de mucina. Es un tumor benigno tiroideo encapsulado que afecta en su mayor parte a mujeres de edad media. Suele presentarse como un nódulo solitario con un tamaño medio entre 1-3 cm. En el patrón histológico muestra una arquitectura macro-microfolicular con presencia de mucina intersticial y en estructuras lacunares. Puede tener cambios a células en anillo de sello o a células claras. Con hematoxilina-eosina, la mucina es basófila, es roja con tinción de mucicarmin y azul con alcian blue, siendo de positividad variable para la tinción con PAS y PAS-diastasa. De igual modo muestra positividad para la mucina tipo MUC1. Las células epiteliales muestran positividad para tiroglobulina, importante en el diagnóstico diferencial, siendo el material mucoide negativo para este marcador. En la revisión de la literatura encontramos 13 casos con mucina en adenomas foliculares y 29 casos en carcinomas primarios tiroideos de distinta índole. Haciendo un recuento anual en nuestros casos con presencia de mucina ocasional, sean adenomas o carcinomas primarios tiroideos, el hallazgo de estos cambios mucinosos focales supone una frecuencia entre 0,25-0,8%, aproximadamente un caso o menos de cada 150 de estas neoplasias. En conclusión, la producción de mucina es un hallazgo no habitual en los adenomas tiroideos. En el diagnóstico diferencial debe considerarse la posibilidad de metástasis u otros tumores tiroideos no derivados del epitelio folicular (AU)
Mucin producing thyroid adenoma is a rare entity affecting mainly middle-aged women. It is a benign, encapsulated tumour presenting as a solitary nodule 1 to 3 cm in size with a macro-microfollicular architecture with areas of interstitial mucin. Occasionally, signet-ring or clear cells are present. The mucin is seen to be basophilic with H&E, stains red with mucicarmin and blue with alcian blue. It is variable for PAS and PAS-Diastase, but shows positivity for MUC1. The epithelial cells stain positive for thyroglobuline, but the mucin is negative. We have found 13 cases of follicular adenomas and 29 cases of thyroid carcinomas with mucinous production in the literature. In our experience, this feature is found in 0.25% to 0.8% of thyroid neoplasms or 1 in 150 annually. In conclusion, mucin production is rare in thyroid adenomas and metastases or other thyroid tumours, including those not derived from the follicular epithelium, in the differential diagnosis (AU)
Subject(s)
Humans , Male , Middle Aged , Adenoma/diagnosis , Adenoma/pathology , Adenocarcinoma, Follicular/complications , Adenocarcinoma, Follicular/diagnosis , Adenocarcinoma, Follicular/pathology , Diagnosis, Differential , Thyroid Gland/pathology , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathologyABSTRACT
El tumor fibroso solitario es una neoplasia mesenquimal de localización tiroidea muy poco usual. Comunicamos el caso de un varón de 42 años con resección del lóbulo tiroideo derecho tras un diagnóstico citológico de proliferación folicular. Macroscópicamente la lesión correspondía a un nódulo encapsulado de 2,5 cm de diámetro máximo. Histológicamente la lesión estaba constituida por una proliferación de células fusiformes que engloban y atrapan a los folículos tiroideos, positivas para vimentina, CD34 y BCL2. El estudio ultraestructural confirmó la naturaleza miofibroblástica de las células neoplásicas (AU)
The thyroid gland is an unusual location for solitary fibrous tumours. We report a case of a 42 year old male with a cytological diagnosis of follicular proliferation. Macroscopically the lesion corresponded to an encapsulated nodule of 2.5 cm. Histologically, it showed a proliferation of spindle cells encompassing thyroid follicles, positive for vimentin, CD34 and BCL2. The ultrastructural study confirmed the myofibroblastic nature of the proliferative cells (AU)
Subject(s)
Humans , Male , Adult , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/pathology , Neoplasms, Fibrous Tissue/pathology , Thyroid Gland/pathology , Chondrosarcoma, Mesenchymal/pathologyABSTRACT
Metastatic neoplasms of the breast are rare. Mammary metastases as the initial presentation are even more infrequent and can simulate a primary malignancy clinically and radiologically. Recognition of metastatic tumors in the breast is important because it would prevent unnecessary mutilating surgery and would lead to appropriate treatment of the primary tumor. There is a broad variety of cytological appearances reported about primary tumors and few reports about secondary breast malignancies, specially diagnosed by FNAC. This study was carried out to examine the clinical and cytomorphologic features of metastatic breast tumors found in 12 de Octubre University Hospital during a period of 20 years. It confirms the utility of FNAC and describes findings that can help in the differential diagnosis that sometimes can be very difficult. Seven cases of nonhematological metastatic neoplasms of the breast were identified from the files of the Department of Pathology of the 12 de Octubre University Hospital from a total of 64,000 aspirates. We included only metastatic tumors from extramammary nonhematological neoplasms. There were nine cases of hematological metastatic neoplasm that were excluded. They were diagnosed with FNAC and confirmed by histopathology, with at least three years of follow up. The breast lump was the first manifestation of malignancy in one case of synovial sarcoma. The other six cases had been previously diagnosed of cancer. These included one malignant melanoma, one alveolar rhabdomyosarcoma, one mixed müllerian tumor, one medullary carcinoma of thyroid, one colonic adenocarcinoma, and one gastric adenocarcinoma. The period of time between primary tumor and metastases ranged from one month to eight years. An accurate cytologic diagnosis was made in all the cases. Immunocytochemistry was available but diagnosis could be made with cytomorphology alone in the seven cases. Fine-needle aspiration cytology is an excellent first line diagnostic modality that is particularly informative when clinical previous data are known. If metastatic disease is suspected, the material obtained by FNAC may provide a definitive diagnosis and prevent open surgical biopsy or mastectomy. We concur with previous reports that FNAC is a reliable, rapid, secure, and cost-effective approach to the diagnosis of palpable metastatic breast tumors.
Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/secondary , Breast/pathology , Neoplasms/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle , Breast Neoplasms/pathology , Child , Female , Humans , Immunohistochemistry , Middle Aged , Staining and Labeling , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Nerve Sheath Neoplasms/pathology , Neurofibrosarcoma/secondary , Lung Neoplasms/pathology , Nevus/pathology , Hair Follicle/pathology , Neoplasm MetastasisABSTRACT
No disponible
Subject(s)
Humans , Chordoma/pathology , Bone Neoplasms/pathology , Notochord/pathology , Biopsy, Fine-Needle/methodsABSTRACT
Este protocolo-guía para el diagnóstico histopatológico del carcinoma hepatocelular es un documento de trabajo de la Subcomisión de Tumores Digestivos del Hospital 12 de Octubre que pretende consensuar un acuerdo intrahospitalario para la utilización de las nomenclaturas acreditadas en la literatura de forma que sean homogéneas y uniformes para evitar malentendidos que lleven a conductas diferentes en el manejo de pacientes con el mismo tipo de lesión. Asimismo, intenta informar a clínicos y radiólogos de lo que pueden esperar del diagnóstico citohistológico de los posibles especimenes de un paciente con diagnóstico sospechado o confirmado de carcinoma hepatocelular
This protocol for the histopathological diagnosis of hepatocellular carcinoma is an internal use document of the Subcommitte of Digestive Tumours of the Hospital 12 de Octubre that intends a consensus in the use of accredited nomenclatures to obtain uniform and homogeneous interpretations aiming analogous and correct managements in patients with similar types of lesions. The protocol also aims to give useful information to clinicians and radiologists about what can they expect of a cyto-histological diagnosis in the specimens of a patient with suspected or confirmed diagnosis of hepatocellular carcinoma
Subject(s)
Humans , Carcinoma, Hepatocellular/pathology , Histocytochemistry/methods , Clinical Protocols , Liver Neoplasms/pathologyABSTRACT
No disponible
Subject(s)
Humans , Chordoma/pathology , Bone Neoplasms/pathology , Notochord/pathology , Biopsy, Fine-Needle/methodsABSTRACT
Este protocolo-guía para el diagnóstico histopatológico del carcinoma hepatocelular es un documento de trabajo de la Subcomisión de Tumores Digestivos del Hospital 12 de Octubre que pretende consensuar un acuerdo intrahospitalario para la utilización de las nomenclaturas acreditadas en la literatura de forma que sean homogéneas y uniformes para evitar malentendidos que lleven a conductas diferentes en el manejo de pacientes con el mismo tipo de lesión. Asimismo, intenta informar a clínicos y radiólogos de lo que pueden esperar del diagnóstico citohistológico de los posibles especimenes de un paciente con diagnóstico sospechado o confirmado de carcinoma hepatocelular
This protocol for the histopathological diagnosis of hepatocellular carcinoma is an internal use document of the Subcommitte of Digestive Tumours of the Hospital 12 de Octubre that intends a consensus in the use of accredited nomenclatures to obtain uniform and homogeneous interpretations aiming analogous and correct managements in patients with similar types of lesions. The protocol also aims to give useful information to clinicians and radiologists about what can they expect of a cyto-histological diagnosis in the specimens of a patient with suspected or confirmed diagnosis of hepatocellular carcinoma
Subject(s)
Humans , Carcinoma, Hepatocellular/pathology , Histocytochemistry/methods , Clinical Protocols , Liver Neoplasms/pathologyABSTRACT
BACKGROUND: Primary papillary serous carcinoma (PPSC) of the peritoneum is a rare neoplasm, histologically indistinguishable from papillary serous carcinoma of the ovary, which diffusely involves the peritoneum but spares or minimally invades the ovaries. To the best of our knowledge, the preoperative and the fine needle aspiration diagnosis of this disorder have not been reported before. CASE: A woman developed an extensive peritoneal neoplasm 4 years after hysterectomy and bilateral salpingo-oophorectomy for benign disease. Fine needle aspiration of the tumor was performed, and the cytologic and immunocytochemical findings were consistent with papillary serous carcinoma. A diagnosis of PPSC of the peritoneum was rendered because review of all slides from previous surgical specimens showed no evidence of carcinoma and no other primary tumors were found elsewhere. CONCLUSION: Fine needle aspiration cytology coupled with immunocytochemical and clinical data allows an unequivocal preoperative diagnosis of papillary serous carcinoma (primary peritoneal or with an ovarian origin). The sole limitation to establish a primary peritoneal origin before surgery is the requirement to histologically study the ovaries. Based on this fact, the preoperative fine needle aspiration cytology diagnosis of PSCP should be restricted to oophorectomized patients.
Subject(s)
Cystadenocarcinoma, Papillary/diagnosis , Cystadenocarcinoma, Serous/diagnosis , Ovarian Neoplasms/diagnosis , Peritoneal Neoplasms/diagnosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Ascites/etiology , Biomarkers, Tumor/analysis , Biomarkers, Tumor/biosynthesis , Biopsy, Fine-Needle/methods , Cystadenocarcinoma, Papillary/drug therapy , Cystadenocarcinoma, Papillary/physiopathology , Cystadenocarcinoma, Serous/drug therapy , Cystadenocarcinoma, Serous/physiopathology , Diagnosis, Differential , Female , Humans , Hysterectomy , Immunohistochemistry/methods , Middle Aged , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/physiopathology , Peritoneal Neoplasms/drug therapy , Peritoneal Neoplasms/physiopathology , Pleural Effusion, Malignant/etiology , Pleural Effusion, Malignant/pathology , Predictive Value of Tests , Treatment OutcomeABSTRACT
BACKGROUND: Skin metastases from hepatocellular carcinoma (HCC) represented only 0.8% of all known cutaneous metastases in a recent large series. The most frequent site appears to be the head, but this fact has received little attention. An accurate cytologic diagnosis is extremely difficult in patients with unknown liver dysfunction. We report the cytologic features of a face metastasis from occult HCC. CASE: A 65-year-old woman presented with a mass in the right preauricular region of 2 months' duration. Her past medical history was noncontributory. Fine needle aspiration cytology was performed. Following the cytologic diagnosis, computed tomography revealed a 6-cm mass in the right lobe of the liver, portal vein thrombosis and involvement of the superior vena cava. The smears were very cellular. The most frequent pattern was trabecular with transmural endothelization. The cells had an epithelial appearance and polyhedral shape, exhibiting distinct borders. The nuclei were centrally placed, with a prominent nucleolus. The cytoplasm was granular. There were numerous atypical bare nuclei. Subsequent staining with antihepatocyte showed positivity in most tumor cells. The final diagnosis was metastatic HCC. CONCLUSION: HCCs should be considered in the differential diagnosis of carcinomas metastatic to the face, even in the absence of liver symptoms.
Subject(s)
Carcinoma, Hepatocellular/secondary , Liver Neoplasms/pathology , Skin Neoplasms/secondary , Skin/pathology , Aged , Biopsy, Fine-Needle , Carcinoma, Hepatocellular/diagnosis , Female , Hepatitis B/complications , Hepatitis C/complications , Humans , Hypertension, Portal/etiology , Hypertension, Portal/physiopathology , Liver/diagnostic imaging , Liver/pathology , Liver/physiopathology , Liver Cirrhosis/complications , Liver Neoplasms/complications , Liver Neoplasms/diagnostic imaging , Portal Vein/pathology , Portal Vein/physiopathology , Skin/physiopathology , Skin Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To describe the cytomorphologic findings of chromophobe renal cell carcinoma (CRCC) in order to preoperatively distinguish this rare neoplasm from other primary or secondary tumors arising from the kidney or presenting as retroperitoneal masses. STUDY DESIGN: Clinical data, fine needle aspiration (FNA) and follow-up surgical specimens from 4 patients with CRCC (3 primaries and 1 metastatic to the liver) were reviewed. Electron microscopy was available for 2 histologic specimens. RESULTS: Two tumors (1 primary and 1 metastatic case) were readily identified as CRCC on FNA. The 2 remaining cases were diagnosed as renal cell carcinoma (RCC) consistent with CRCC. All tumors showed aspirates with moderate to high cellularity, with the cells arranged in small clusters and single cells. Neoplastic cells had abundant heterogeneous cytoplasm, a thickened cell membrane, nuclear hyperchromasia, nuclear outline irregularity, significant nuclear size variation, intranuclear inclusions and frequent binucleation. Histology of the 4 renal tumors was characteristic of CRCC, with positivity for Hale's colloidal iron in all cases. Ultrastructurally, characteristic cytoplasmic microvesicles were observed in the 2 cases that we studied. CONCLUSION: In the adequate clinicoradiologic setting, CRCC has distinctive cytologic features that may allow an accurate preoperative FNA diagnosis.
Subject(s)
Carcinoma, Renal Cell/pathology , Kidney Neoplasms/pathology , Aged , Biopsy, Fine-Needle , Carcinoma, Renal Cell/surgery , Female , Humans , Immunohistochemistry , Kidney Neoplasms/surgery , Male , Middle Aged , NephrectomyABSTRACT
BACKGROUND: Lymphoepithelioid cell lymphoma (LCL) is a rare morphologic variant of peripheral T-cell lymphoma. Although their histopathologic and immunohistochemical findings are well known, the cytopathologic features have not been well documented. This report describes the fine needle aspiration cytology (FNAC) findings of a case of LCL. CASE: A 75-year-old woman presented with cervical, supraclavicular, axillary and mediastinal lymphadenopathy. FNAC of a cervical lymph node was performed. The smears contained a polymorphous infiltrate formed by abundant histiocytes disposed singly or in clusters, small and medium-sized to large atypical lymphoid cells and reactive cells, including eosinophils and plasma cells. Isolated capillary-sized vessels also were observed. Histopathologic and immunohistochemical examination confirmed the diagnosis of Lennert's lymphoma. CONCLUSION: Although histopathologic and immunohistochemical studies were required for a definitive diagnosis, the findings of FNAC in this case appeared distinctive and suggested the possibility of LCL.
Subject(s)
Lymph Nodes/pathology , Lymphatic Diseases/pathology , Lymphoma, T-Cell/pathology , Aged , Antigens, Surface/metabolism , Biomarkers, Tumor/metabolism , Biopsy, Fine-Needle , Cell Size/physiology , Epitopes, T-Lymphocyte/immunology , Female , Humans , Lymphatic Diseases/etiology , Lymphocytes/immunology , Lymphocytes/pathologyABSTRACT
BACKGROUND: Neurothekeoma (NT) is a rare, benign neoplasm of soft parts with a distinctive histologic appearance. To our knowledge, the cytologic findings have not been described before. We present a case of NT with the cytologic features on fine needle aspiration cytology (FNAC). CASE: A 54-year-old female presented with a circumscribed nodule in the left breast. The lesion was evaluated by FNAC. The smears showed an abundant, metachromatic, myxoid matrix with fusiform and epithelioid cells, some binucleated or multinucleated, loose or in groups and sometimes forming concentric whorls. The lesion was removed, and the diagnosis of NT was made after histopathologic study. CONCLUSION: NT is an extremely rare neoplasm in the mammary region. Fusiform and epithelioid cells arranged in concentric whorls in a myxoid tumor of soft tissue are a distinctive characteristic of this neoplasm and can suggest the diagnosis.
Subject(s)
Biopsy, Needle/methods , Breast/pathology , Neurothekeoma/pathology , Soft Tissue Neoplasms/pathology , Biomarkers, Tumor/analysis , Breast/surgery , Epithelioid Cells/pathology , Female , Humans , Immunohistochemistry , Middle Aged , Neurothekeoma/chemistry , Neurothekeoma/surgery , Soft Tissue Neoplasms/chemistry , Soft Tissue Neoplasms/surgery , Vimentin/analysisABSTRACT
El diagnóstico en punción aspiración con aguja fina de "Proliferación-Neoplasia Folicular" en la patología tiroidea es poco preciso en determinar la condición neoplásica benigna o maligna de las lesiones foliculares. Este diagnóstico se basa en que haya celularidad folicular destacable o aumentada de carácter neoplásico y escaso o ausente coloide de fondo, tratando de establecer un diagnóstico concreto de benignidad o malignidad, con prioridad en este último de la exéresis quirúrgica. En este trabajo relatamos nuestra experiencia en 200 casos con el diagnóstico citopatológico de "Proliferación Folicular" y la exéresis quirúrgica, excluyendo los diagnósticos de benignidad (Bocios Coloides, Tiroiditis) o malignidad (Carcinoma Papilar, Medular u otros) con características propias. Tras el examen histológico, 83 casos (42 por ciento) fueron lesiones benignas (71, Hiperplasia Uni o Multinodular; 6, Hiperplasia Difusa y 6, Tiroiditis Linfocitaria Crónica). 65 (32,5 por ciento) correspondieron a Adenomas Foliculares.52 casos (26 por ciento) fueron Carcinomas: (27, Carcinoma Papilar; 20, Carcinoma Folicular; 3, Carcinoma Medular; 1, Carcinoma Epidermoide de Laringe poco diferenciado; 1, Carcinoma Metastásico de Colon). En 58 casos (29 por ciento) se enunció ademas el diagnóstico de Sospecha de malignida, confirmándose en 39 (68 por ciento) la presencia de carcinoma. Se postula que en el 70 por ciento de estos diagnósticos, deben ser prioritarios para la cirugía por su carácter neoplásico, tratando de delimitar las lesiones neoplásicas más agresivas. La media de la exéresis quirúrgica en los casos que fueron Carcinomas fue de 11298 días (AU)
Subject(s)
Humans , Carcinoma, Papillary, Follicular/pathology , Thyroid Neoplasms/pathology , Biopsy, Needle/methods , Thyroiditis, Autoimmune/pathology , Goiter/pathology , Carcinoma, Medullary/pathology , Carcinoma, Papillary/pathology , Thyroiditis, Suppurative/pathology , Immunohistochemistry/statistics & numerical dataABSTRACT
We report on our experience in fine-needle aspiration (FNA) biopsy of the retroperitoneum: 111 FNA biopsies performed on 99 patients. Cytologic diagnoses were divided into four groups: nondiagnostic (unsatisfactory samples because of a low cellularity and/or improperly prepared smears) aspirates (20%), benign (16%), suspicious for malignancy (13%), and malignant (50%). There were no known false-positive samples. We had two false-negative diagnoses due to sampling errors. Among diagnostic smears, the procedure showed a sensitivity of 97% and a specificity of 100%. The predictive value of a positive result was 100% and the predictive value of a negative result was 90%. The overall accuracy was 98%. Metastatic carcinomas accounted for the largest number of lesions in the group of malignant tumors. A primary tumor site was known for the majority of the cases before the aspiration was performed. In the remaining cases we were unable to suggest an origin. It is therefore important to emphasize the role of ancillary studies in patients that are at the first assessment of the disease or when a second intercurrent malignancy is suspected. In our limited experience, a suggestion of the correct subtype of retroperitoneal sarcoma was not possible. As in the rest of cytopathology, a multidisciplinary approach is mandatory in this setting to improve patient management.
