Investigation strategy in the management of metastatic adenocarcinoma of unknown primary presenting as cervical lymphadenopathy.

CONCLUSION: Computed tomography (CT) of the neck, chest, abdomen and pelvis is the most appropriate initial investigation following a fine needle aspiration cytology (FNAC) diagnosis of metastatic adenocarcinoma in cervical lymph nodes with unknown primary. PET-CT should be considered as the next step if the initial CT fails to identify the primary site, but its true value is yet to be determined. OBJECTIVE: To review investigation strategies for metastatic adenocarcinoma of unknown primary presenting as cervical lymphadenopathy, and to develop a management algorithm. METHODS: This was a retrospective case note study from two regional head and neck cancer centres in the UK. Adult patients with FNAC diagnosis of metastatic adenocarcinoma in cervical lymph nodes between 1998 and 2008, with a minimum 5-year follow-up, were included. Patients with a clinically obvious primary tumour or a previous history of adenocarcinoma were excluded. RESULTS: This study examined 41 cases. CT of the neck, chest, abdomen and pelvis was the most useful initial investigation. It identified the primary tumour site in 16/28 cases (57%), detected the primary tumour and led to revision of the FNAC diagnosis in 1 case (2.4%), and was necessary for the final diagnosis of true unknown primary in 12 cases (29.3%). Targeted imaging was not helpful.

Maxillary cementifying fibroma: a case report with fine-needle aspiration cytology highlighting the expanding role of e-medicine in cytopathologist collaborations.

Cementifying fibroma is an uncommon fibro-osseous lesion presenting in the oral cavity, which may present in children as an aggressive juvenile subtype of either psammomatoid or trabecular variant. Appropriate management, to achieve local control and prevent destructive expansion, requires early diagnosis, which fine-needle aspiration cytology (FNAC) can provide rapidly in a minimally invasive manner. The role of FNAC is even more powerful in situations where medical facilities are limited or where surgical biopsy is contraindicated. We report a case of a 6-year-old boy from Lagos, Nigeria, whose initial diagnosis of cementifying fibroma was made on photographed digital images in jpeg format of FNAC slides, which were then e-mailed as attachments to Sydney, Australia and to Scottsdale, USA. The tumor was subsequently confirmed as a juvenile trabecular variant of cementifying fibroma on histopathology on a surgical excision in London, United Kingdom. The ability to electronically send cytopathology images around the world for a definitive second opinion is a practical example of the power of e-medicine to achieve an accurate FNAC diagnosis.

Value of fine needle aspiration cytology in head and neck lymphoma: experience in a head and neck cancer unit in the United Kingdom.

CONCLUSION: In our experience, fine needle aspiration cytology (FNAC) combined with immunocytochemistry/flow cytometry in the investigation of lymphoma presenting in the neck is highly valuable. In our unit it has a sensitivity of 95.5% and a positive predictive value (PPV) of 96.8% and is the first-line investigation in suspected lymphoma. It enables planning of radiological and haematological investigations and obviates panendoscopy as part of the staging protocol. OBJECTIVE: Lymphoma commonly presents to otolaryngologists. The aim of our study was to evaluate the accuracy of FNAC in lymphoma presenting in the neck at our institute. METHODS: Data were collected retrospectively between 2003 and 2007. Separate searches for cytological and histopathological diagnosis of lymphoma on cervical lymph node biopsies were cross-referenced. Immunocytochemistry stains used were recorded. RESULTS: A total of 121 cases met the inclusion criteria. The FNAC diagnosis of lymphoma was correct on lymph node biopsy in 68.6% (83/121). In 18 (14.9%) cases a false-negative result and in 3 (2.5%) cases a false-positive result was seen. In all, 17 (14.0%) cases were non-diagnostic (11 inadequate and 6 suspicious). In 16/20 (80.0%) cases of wrong diagnosis, immunocytochemistry had not been performed. Flow cytometry and immunocytochemistry were used in 67 cases and the FNAC diagnosis had a sensitivity of 95.5% and a PPV of 96.8% in this group.