Fine-needle aspiration biopsy as an initial diagnostic modality in a clinically unsuspected case of invasive maxillary fungal sinusitis: A case report.

Cases of invasive fungal lesions involving the paranasal sinuses are generally diagnosed either on histologic examination or on fungal culture. Here, we report a case of invasive fungal sinusitis diagnosed primarily by a fine-needle aspiration biopsy (FNAB).Our patient was a 36-year-old male who presented with a history of slowly progressive, painless swelling over the left cheek. The only positive clinical finding was a bony hard swelling in the left maxillary region, which was clinically interpreted as "fibrous dysplasia." A computed tomographic (CT) examination of the paranasal sinuses showed a soft tissue attenuation lesion involving the bilateral maxillae, with the destruction of multiple bones and involvement of multiple sinuses and the bilateral orbits. FNAB of the maxillary swelling showed several giant cells, many of them exhibiting ingested organisms with a morphologic resemblance to the Aspergillus species of fungi. Strikingly, no significant inflammatory cells were seen on cytologic smears. Unfortunately, owing to a lack of initial clinical suspicion, as well as the patient's loss to further follow-up, a culture/histopathologic examination could not be carried out.This case is presented chiefly to highlight the clinical utility of a simple FNAB procedure, as an initial diagnostic modality in cases of fungal sinusitis, which can masquerade clinically as a neoplastic lesion. In addition, if radiologic findings are also available at the time of cytologic examination, a pretherapeutic comment on the invasive nature of the lesion can also be made.

Preoperative cytodiagnosis of pleomorphic adenoma with extensive lipometaplasia: a case report.

BACKGROUND: Pleomorphic adenoma with extensive lipometaplasia is a rare, benign tumor of salivary gland origin. To the best of our knowledge, the fine needle aspiration cytologic features of this distinct morphologic entity have not been docnmented before. CASE: A 48-year-old male presented with right-sided parotid swelling that was clinically diagnosed as a pleomorphic adenoma. Fine needle aspiration yielded sticky, fatty material; the smears showed features of pleomorphic adenoma with intimately associated, abundant adipose tissue elements. A cytodiagnosis of pleomorphic adenoma with extensive lipometaplasia was rendered and confirmed by histopathologic examination. CONCLUSION: Pleomorphic adenoma with extensive lipometaplasia is an unusual benign salivary gland tumor with distinct histomorphology. Cytologically, it is characterized by the presence of an excessive amount of intimately associated adipose tissue in an otherwise-classic pleomorphic adenoma.

Pure neuritic leprosy with nerve abscess presenting as a cystic, soft tissue mass: report of a case diagnosed by fine needle aspiration cytology.

Pure neuritic leprosy (PNL) with nerve abscess manifesting as a huge, cystic, soft tissue mass is highly uncommon. Fine needle aspiration cytology can serve as an important initial diagnostic modality in such an instance. We report a case of 28-year-old male, who presented with a huge swelling in the lower, medial aspect of the right upper arm. The clinical diagnosis was schwannoma. Fine needle aspiration (FNA) yielded 80 ml of sticky, turbid, pale brown fluid. Cytologic examination revealed abundant, caseous, necrotic material and many degenerated neutrophils in a thin proteinaceous background. Stain for acid fast bacilli (AFB) was negative. Based on an AFB negative, caseous, necrotic material obtained from the soft tissue mass located in the ulnar nerve region, a cytodiagnosis of tuberculoid PNL with nerve abscess was given, and this was confirmed by the subsequent histopathologic examination. Our case emphasizes the major role of minimally traumatic, FNA technique in the diagnosis of rare cases of clinically unsuspected neuritic leprosies.