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Lajara S, Jo VY. Soft Tissue Fine-Needle Aspiration: Current and Future Impact on Patient Care. Surg Pathol Clin 2024; 17:483-507. [PMID: 39129144 DOI: 10.1016/j.path.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Soft tissue neoplasms pose many diagnostic challenges on fine-needle aspiration (FNA), owing largely to their rarity, large number of entities, and histologic diversity. Advances in ancillary testing now allow detection of the characteristic immunophenotypes and molecular alterations for many neoplasms and include reliable surrogate immunohistochemical markers for underlying molecular events that are highly efficient in small biopsies. A morphology-based framework is recommended to guide appropriate differentials and judicious selection of ancillary tests for small biopsies. The accurate diagnosis of soft tissue tumors is crucial for patient management and prognostication, with many potential implications in this era of precision medicine.
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Affiliation(s)
- Sigfred Lajara
- Department of Pathology, UPMC Shadyside Hospital, Cancer Pavilion, Suite 201, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Vickie Y Jo
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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2
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Mittenzwei R, Yoda RA. Cytological features of cranial and paraspinal nerve Tumours. Cytopathology 2024; 35:572-580. [PMID: 38041220 DOI: 10.1111/cyt.13339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
The 2021 World Health Organization Classification of Central Nervous System Tumours introduced significant revisions to the categorization of paraspinal and nerve sheath tumours. This updated system encompasses seven tumour types: schwannoma, neurofibroma, perineurioma, hybrid nerve sheath tumours, malignant melanotic nerve sheath tumour, malignant peripheral nerve sheath tumour and cauda equina neuroendocrine tumour. This review provides an image-rich cytologic reference of these tumours, with particular emphasis on intraoperative smear preparations. Knowledge of the key cytological features of these tumours and their differential diagnoses will help guide classification of these challenging entities.
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Affiliation(s)
- Rhonda Mittenzwei
- King County Medical Examiner's Office, Seattle, Washington, USA
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Rebecca A Yoda
- Division of Neuropathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Division of Cytopathology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Shaker N, Iwenofu H, Shaker N, Tynski Z, Sangueza OP, Abid A. Myxoid neurofibroma masquerading as lymphatic-venous malformation and poses a diagnostic challenge on fine needle aspiration biopsy. Diagn Cytopathol 2024; 52:E111-E115. [PMID: 38363063 DOI: 10.1002/dc.25288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Myxoid neurofibromas (NF) are uncommon, benign spindle cell tumors that originate from peripheral nerve sheaths, often posing a diagnostic challenge due to their hypocellularity on cytology specimens. Distinguishing myxoid spindle cell lesions can be challenging, given the broad range of potential differential diagnoses. CASE PRESENTATION A 26-year-old female with a past medical history of embolized inguinal, flank, and retroperitoneal venolymphatic malformation presented with a left pelvic pain causing significant disability. CT scan showed an extensive 8.7 cm × 6.6 cm retroperitoneal mass. FNA was performed and alcohol-fixed papanicolaou-stained smears showed a hypocellular specimen with loosely arranged clusters of bland spindle cell proliferation in the background of a mucoid matrix. Spindle cells showed scant cytoplasm and elongated oval-shaped regular nuclei. Prominent nucleoli were not seen. An excisional biopsy revealed a bland spindle cell proliferation in a myxoid background associated with shredded collagen bundles. Immunohistochemical staining showed diffuse positivity for S100 and CD34. Based on the overall findings, a definitive diagnosis of myxoid neurofibroma was rendered. DISCUSSION Cytological features of myxoid neurofibroma include the presence of hypocellular spindle-shaped cells arranged in small, loosely organized groups within a myxoid matrix background. Cells exhibit scant cytoplasm with regular oval and elongated nuclei. Nucleoli are typically not identified. The differential diagnosis includes myxoid neurofibroma, myxoma, myxoid liposarcoma, myxoid chondrosarcoma, myxoid dermatofibrosarcoma protuberans, low-grade fibromyxoid sarcoma, and low-grade myxo-fibrosarcoma. CONCLUSION We aim to highlight the importance of considering myxoid neurofibroma in the differential diagnosis of hypocellular myxoid spindle cell lesions encountered on fine-needle aspiration cytology.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center/James Cancer Hospital, Columbus, Ohio, USA
| | - Hans Iwenofu
- Department of Pathology, The Ohio State University Wexner Medical Center/James Cancer Hospital, Columbus, Ohio, USA
| | - Nuha Shaker
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zofia Tynski
- Hackensack Meridian Health, Mountainside Medical Center, Montclair, New Jersey, USA
| | - Omar P Sangueza
- Department of Dermatology and Dermatopathology, Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Abdul Abid
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA
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Rekhi B, Qian X, Domanski HA, Klijanienko J, Field A. Pitfalls in soft tissue cytopathology. Cytopathology 2024; 35:30-47. [PMID: 37548096 DOI: 10.1111/cyt.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
Fine needle aspiration biopsy (FNAB) is a diagnostic modality for the evaluation of suspicious soft tissue masses. Despite its reasonable sensitivity, specificity and positive predictive value in differentiating benign from malignant neoplasms, the exact subtyping of the primary soft tissue tumours can be challenging. Certain tumours constitute "pitfalls" and add to the diagnostic challenge. This review provides a detailed account of the diagnostic challenges in soft tissue cytopathology, including pitfalls and, more importantly, the ways to overcome these challenges by integrating clinical details, key cytomorphological features and judicious application of ancillary techniques.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Bone and Soft Tissues, Disease Management Group (DMG) Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Xiaohua Qian
- Department of Pathology, Cytopathology Service and Bone and Soft Tissue Service, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Andrew Field
- Department of Anatomical Pathology, St. Vincent's Hospital, University of New South Wales Sydney and Notre Dame University Sydney Clinical Medical Schools, Sydney, New South Wales, Australia
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Clements MA, Gallagher S, Herrmann GE. Unexplained Gait and Balance Changes: A Case Report of Myxoma Mitigation in a Breast Reduction Patient. Workplace Health Saf 2022; 70:298-301. [PMID: 35341402 DOI: 10.1177/21650799211070734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Fall 2020, a female physical therapist (PT) developed mild changes in gait, infrapatellar tendon pain, and lateral patellar tracking. As a PT in good physical condition, she did not access her employer's occupational health clinic but instead she self-treated. Two months after symptom onset and self-treatment, she was diagnosed with an intramuscular myxoma within her left vastus lateralis, the largest muscle within the quadricep. The employee was at risk of slips, trips, and falls as the mass grew. Due to the location and increasing size of the mass, the employee required surgical treatment. Healthcare workers, particularly those who provide treatment, are likely to self-treat rather than seek assistance from the occupational health professional. The employee was seen by a plastic surgeon for an unrelated medical condition which is when the myxoma was diagnosed. Further delay may have led to occupational injury associated with the balance and gait disturbances. Opportunity exists for the occupational health professional to provide a review of services, including screening for musculoskeletal changes associated with occupational injury such as those described herein. This is especially important among those healthcare workers who tend to self-treat.
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Layfield LJ, Dodd L, Klijanienko J. Myxoid neoplasms of bone and soft tissue: a pattern-based approach. J Am Soc Cytopathol 2020; 10:278-292. [PMID: 33168472 DOI: 10.1016/j.jasc.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The accurate diagnosis of musculoskeletal neoplasms is difficult but a pattern-based approach combined with ancillary testing has been shown to improve diagnostic accuracy. The pattern-based approach is particularly appropriate for myxoid lesions. MATERIALS AND METHODS The authors reviewed their personal experience of over 3 decades of diagnosing myxoid neoplasms of musculoskeletal lesions. RESULTS The authors found that myxoid lesions can be accurately classified based on cell type, nuclear atypia, presence of blood vessel fragments, as well as the results of immunohistochemical and molecular testing. CONCLUSIONS Musculoskeletal lesions with a prominence of myxoid or chondroid material in the background can be accurately diagnosed using pattern analysis and ancillary testing.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri.
| | - Leslie Dodd
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
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Rodriguez EF, Jones R, Miller D, Rodriguez FJ. Neurogenic Tumors of the Mediastinum. Semin Diagn Pathol 2020; 37:179-186. [PMID: 32448592 DOI: 10.1053/j.semdp.2020.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 12/15/2022]
Abstract
Neurogenic tumors represent a broad ill-defined category of neoplasms that includes tumors of Schwann cell and/or neuroblastic derivation, as well as neoplasms that typically develop in the central nervous system, but rarely present in ectopic sites including the mediastinum. Neurogenic tumors may occur at many different anatomic sites, but the mediastinum represents a uniquely challenging site given the complex anatomy. Additionally, some of these neoplasms may present with multicentric involvement in the context of genetic syndromes, including NF1, NF2 and schwanomatosis. Most of these develop in posterior structures, often in association with paraspinal structures. Fine needle biopsy/small biopsies play an important role in the diagnosis of these neoplasms, given its record of safety and the increased applicability of ancillary testing to these smaller samples at the present time. In this review we focus on the major categories of neurogenic tumors that may be encountered in the mediastinum, including schwannoma, neurofibroma, malignant peripheral nerve sheath tumors, ganglioneuroma and ganglioneuroblastoma, as well as rarer members of this category. We discuss diagnostic approaches applicable to small cytologic and tissue samples and relevant differential diagnoses.
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Affiliation(s)
- Erika F Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Robert Jones
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Miller
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
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Papke DJ, Jo VY. Practical Application of Cytology and Core Biopsy in the Diagnosis of Mesenchymal Tumors. Surg Pathol Clin 2019; 12:227-248. [PMID: 30709446 DOI: 10.1016/j.path.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Soft tissue neoplasms are increasingly being sampled by core needle biopsy and fine-needle aspiration (FNA), and these small biopsy specimens pose unique diagnostic challenges. Many advances in ancillary testing enable detection of characteristic immunophenotypes and molecular alterations, allowing accurate classification of soft tissue tumors in these small biopsy samples. This review outlines pattern-based diagnostic approaches to core biopsies and FNAs of soft tissue neoplasms, including formulation of practical differential diagnoses and relevant application of ancillary tests.
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Affiliation(s)
- David J Papke
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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9
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Abstract
Soft tissue neoplasms are diagnostically challenging, although many advances in ancillary testing now enable accurate classification of fine-needle aspiration biopsies by detection of characteristic immunophenotypes (including protein correlates of molecular alterations) and molecular features. Although there are many useful diagnostic immunohistochemical markers and molecular assays, their diagnostic utility relies on correlation with clinical and morphologic features, judicious application, and appropriate interpretation because no single test is perfectly sensitive or specific. This review discusses applications of ancillary testing for commonly encountered soft tissue neoplasms in cytopathologic practice in the context of a pattern-based approach.
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Affiliation(s)
- Vickie Y Jo
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Chebib I, Jo VY. Application of ancillary studies in soft tissue cytology using a pattern‐based approach. Cancer Cytopathol 2018; 126 Suppl 8:691-710. [DOI: 10.1002/cncy.22030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ivan Chebib
- James Homer Wright Pathology Laboratories Massachusetts General Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
| | - Vickie Y. Jo
- Department of Pathology Brigham and Women’s Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
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Batra N, Gordetsky J, Kelly D, Dangle PP. Case: Pediatric paratesticular soft tissue perineurinoma - A rare entity. Can Urol Assoc J 2017; 12:E40-E41. [PMID: 29173268 DOI: 10.5489/cuaj.4883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Soft tissue perineuriomas are rare but benign tumours that are composed of peripheral nerve sheath and are most commonly located in the extremity. Diagnosis is confirmed by the immunohistochemical and ultrastructural features of the tumour. Paratesticular location is extremely rare; so far, only one case is reported. Herein, we report a second case of perineurioma in a 16-year-old male in the paratesticular region.
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Affiliation(s)
- Neha Batra
- The University of Alabama at Birmingham Medical School; Birmingham, AL, United States
| | | | - David Kelly
- Children's Of Alabama, University of Alabama; Birmingham, AL, United States
| | - Pankaj P Dangle
- Children's Of Alabama, University of Alabama; Birmingham, AL, United States
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Wei S, Henderson-Jackson E, Qian X, Bui MM. Soft Tissue Tumor Immunohistochemistry Update: Illustrative Examples of Diagnostic Pearls to Avoid Pitfalls. Arch Pathol Lab Med 2017; 141:1072-1091. [PMID: 28745570 DOI: 10.5858/arpa.2016-0417-ra] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT - Current 2013 World Health Organization classification of tumors of soft tissue arranges these tumors into 12 groups according to their histogenesis. Tumor behavior is classified as benign, intermediate (locally aggressive), intermediate (rarely metastasizing), and malignant. In our practice, a general approach to reaching a definitive diagnosis of soft tissue tumors is to first evaluate clinicoradiologic, histomorphologic, and cytomorphologic features of the tumor to generate some pertinent differential diagnoses. These include the potential line of histogenesis and whether the tumor is benign or malignant, and low or high grade. Although molecular/genetic testing is increasingly finding its applications in characterizing soft tissue tumors, currently immunohistochemistry still not only plays an indispensable role in defining tumor histogenesis, but also serves as a surrogate for underlining molecular/genetic alterations. Objective- To provide an overview focusing on the current concepts in the classification and diagnosis of soft tissue tumors, incorporating immunohistochemistry. This article uses examples to discuss how to use the traditional and new immunohistochemical markers for the diagnosis of soft tissue tumors. Practical diagnostic pearls, summary tables, and figures are used to show how to avoid diagnostic pitfalls. DATA SOURCES - Data were obtained from pertinent peer-reviewed English-language literature and the authors' first-hand experience as bone and soft tissue pathologists. CONCLUSIONS - -The ultimate goal for a pathologist is to render a specific diagnosis that provides diagnostic, prognostic, and therapeutic information to guide patient care. Immunohistochemistry is integral to the diagnosis and management of soft tissue tumors.
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Affiliation(s)
| | | | | | - Marilyn M Bui
- From the Department of Pathology, The University of Alabama at Birmingham, Birmingham (Dr Wei); the Departments of Anatomic Pathology (Drs Henderson-Jackson and Bui) and Sarcoma (Dr Bui), Moffitt Cancer Center, Tampa, Florida; Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, and Dana Farber Cancer Institute, Boston, Massachusetts (Dr Qian); and the Department of Cytopathology Fellowship, Morsani College of Medicine at the University of South Florida, Tampa (Dr Bui)
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Mohamed M, Fisher C, Thway K. Low-grade fibromyxoid sarcoma: Clinical, morphologic and genetic features. Ann Diagn Pathol 2017. [DOI: 10.1016/j.anndiagpath.2017.04.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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