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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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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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3
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Wang C, Zhang Z, Dou Y, Liu Y, Chen B, Liu Q, Wang S. Development of clinical and magnetic resonance imaging-based radiomics nomograms for the differentiation of nodular fasciitis from soft tissue sarcoma. Acta Radiol 2023; 64:2578-2589. [PMID: 37593946 DOI: 10.1177/02841851231188473] [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: 08/19/2023]
Abstract
BACKGROUND Accurate differentiation of nodular fasciitis (NF) from soft tissue sarcoma (STS) before surgery is essential for the subsequent diagnosis and treatment of patients. PURPOSE To develop and evaluate radiomics nomograms based on clinical factors and magnetic resonance imaging (MRI) for the preoperative differentiation of NF from STS. MATERIAL AND METHODS This retrospective study analyzed the MRI data of 27 patients with pathologically diagnosed NF and 58 patients with STS who were randomly divided into training (n = 62) and validation (n = 23) groups. Univariate and multivariate analyses were performed to identify the clinical factors and semantic features of MRI. Radiomics analysis was applied to fat-suppressed T1-weighted (T1W-FS) images, fat-suppressed T2-weighted (T2W-FS) images, and contrast-enhanced T1-weighted (CE-T1W) images. The radiomics nomograms incorporating the radiomics signatures, clinical factors, and semantic features of MRI were developed. ROC curves and AUCs were carried out to compare the performance of the clinical factors, radiomics signatures, and clinical radiomics nomograms. RESULTS Tumor location, size, heterogeneous signal intensity on T2W-FS imaging, heterogeneous signal intensity on CE-T1W imaging, margin definitions on CE-T1W imaging, and septa were independent predictors for differentiating NF from STS (P < 0.05). The performance of the radiomics signatures based on T2W-FS imaging (AUC = 0.961) and CE-T1W imaging (AUC = 0.938) was better than that based on T1W-FS imaging (AUC = 0.833). The radiomics nomograms had AUCs of 0.949, which demonstrated good clinical utility and calibration. CONCLUSION The non-invasive clinical radiomics nomograms exhibited good performance in the differentiation of NF from STS, and they have clinical application in the preoperative diagnosis of diseases.
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Affiliation(s)
- Chunjie Wang
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Zhengyang Zhang
- Department of Radiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, PR China
| | - Yanping Dou
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Yajie Liu
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Bo Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, PR China
| | - Qing Liu
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, PR China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, PR China
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4
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Georgantzoglou N, Linos K. An update on selected cutaneous (myo) fibroblastic mesenchymal tumors. Semin Diagn Pathol 2023; 40:295-305. [PMID: 37150655 PMCID: PMC10602371 DOI: 10.1053/j.semdp.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
Cutaneous (myo)fibroblastic tumors constitute a group of tumors with overlapping clinicopathological features and variable biologic behavior. In the present review we focus on the histomorphology, immunohistochemical profile and molecular background of the following entities: dermatofibrosarcoma protuberans (DFSP), CD34-positive fibroblastic tumor (SCD34FT), myxoinflammatory sarcoma (MIFS), low-grade myofibroblastic sarcoma, solitary fibrous tumor and nodular fasciitis. Although some of these entities typically arise in deep-seated locations, they may occasionally present as cutaneous/superficial tumors and might be challenging to recognize. This review covers in depth the latest advances in molecular diagnostics and immunohistochemical markers that have significantly facilitated the correct classification and diagnosis of these neoplasms.
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Affiliation(s)
- Natalia Georgantzoglou
- Department of Pathology & Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Konstantinos Linos
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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5
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Butta S, Khatun F, Mohin M, Chatterjee U. Pitfalls in the cytological diagnosis of nodular fasciitis: A report of two cases. Cytopathology 2023; 34:161-164. [PMID: 36401790 DOI: 10.1111/cyt.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/26/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
Cytological diagnosis of nodular fasciitis can be challenging. The main features on cytological smears are bland, round to ovoid cells with fuzzy cytoplasmic processes in a background of focal myxoid change. The cytological features of two cases of nodular fasciitis are described here, along with the cytological differentials.
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Affiliation(s)
| | | | - Md Mohin
- Department of Pathology, IPGME&R, Kolkata, India
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6
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Luo W, Ma T, Wang S, Qin X, Jiang L, Wang Y, Zhang T. Nodular Fasciitis of the Nose and External Auditory Canal: Two Rare Case Reports. EAR, NOSE & THROAT JOURNAL 2023:1455613221115142. [PMID: 36651145 DOI: 10.1177/01455613221115142] [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: 01/19/2023] Open
Abstract
Nodular fasciitis(NF) is a proliferative disease of fibroblasts and myofibroblasts that generally affects subcutaneous tissue, muscle tissue, and fascia. NF usually occurs in young adults aged 20-40 and is more common in the upper extremities and relatively rare in the region of the head and neck. Here, we report on two patients with NF in the ear and nose. Under general anesthesia, the masses of NF were completely resected along the safety margin. The patients recovered well after surgery and there was no recurrence after more than half a year of follow-up.
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Affiliation(s)
- Wanjie Luo
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianyu Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Siqi Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaowei Qin
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuyao Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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7
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Rottmann D, Pantanowitz L. Approach to Fine Needle Aspiration of Giant Cell-rich Tumors of Soft Tissue. Adv Anat Pathol 2022; 29:401-411. [PMID: 35918292 DOI: 10.1097/pap.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Giant cells may be found in a wide variety of reactive and neoplastic soft tissue lesions. Because of their distinct histomorphology, they often stand out in procured samples such as fine needle aspirates. The giant cells themselves may be benign or neoplastic. However, the presence, type, and quantity of giant cells are usually not specific and in some cases can even be misleading when making a diagnosis. The aim of this review is to guide the practicing cytopathologist in narrowing their differential diagnosis when encountering one of these challenging giant cell-rich lesions of the soft tissue.
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Abstract
Myxoid tumors of the soft tissue encompass a group of heterogenous tumors that are characterized by the presence of abundant extracellular myxoid or chondromyxoid matrix material. Fine needle aspiration (FNA) is variably used for diagnosing primary, recurrent, and metastatic myxoid soft tissue tumors. The spectrum of myxoid soft tissue tumors encountered in practice ranges from benign lesions such as simple ganglion cysts to high-grade malignant sarcomas such as myxofibrosarcoma. These myxoid tumors have clinical, cytologic, and histologic overlap. Therefore, making an accurate diagnosis by FNA alone is challenging. Despite this challenge, using a systematic cytomorphologic approach and ancillary studies, an accurate diagnosis is feasible in the majority of cases. This article provides a systematic approach to diagnosing myxoid soft tissue tumors by FNA along with a review of the literature.
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Affiliation(s)
- Swati Satturwar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
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9
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Wakely PE. Mesenchymal neoplasms of the parotid gland and parapharyngeal space: an FNA cytologic study of 22 nonlipomatous tumors. Cancer Cytopathol 2022; 130:443-454. [PMID: 35195952 DOI: 10.1002/cncy.22562] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mesenchymal neoplasms of the parotid gland (PG) and para-pharyngeal (PP) space are distinctly uncommon. Fine-needle aspiration (FNA) biopsy experience with nonlipomatous neoplasms from this site is reviewed. METHODS Cytopathology and surgical pathology files were examined for mesenchymal PG and PP space neoplasms. FNA biopsy was performed using standard technique. RESULTS Twenty-two PG and/or PP aspirates from 20 adults (male:female = 1.1:1; age range, 19-84 years, mean age, 50 years) and a 10-week-old infant met inclusion criteria. Biopsy sites included PG (17, 77%) or PP space (5, 23%). Five of 6 malignant neoplasms (83%) were called malignant cytologically. Only 7 of 11 (63%) benign neoplasms were recognized as a benign neoplasm. None of 5 solitary fibrous tumor (SFT) cases were correctly recognized. Conversion to the Milan classification showed 8 (36%) FNA cases diagnosed as benign neoplasm, 6 (27%) malignant neoplasm, 4 (18%) neoplasm of uncertain malignant potential, 2 (9%) nondiagnostic, and single cases of suspicious for malignancy and nonneoplastic. There was 1 false-positive and no false-negative FNA diagnoses. Ancillary testing in 10 (45%) aspirates helped substantiate a correct specific diagnosis in 3 malignant and 3 benign cases. CONCLUSIONS FNA biopsy of nonlipomatous mesenchymal SG neoplasms is particularly challenging. Less than half (9 of 11, 41%) had specific FNA diagnoses that correctly matched the tissue diagnoses or clinical outcome. Accurate Milan categorization was superior for malignant neoplasms (5 of 6, 83%) in contrast to benign neoplasms (7 of 11, 63%), or neoplasms of uncertain malignant potential (SFT) (2 of 5, 40%).
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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10
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Chu CL, Lu YJ, Lee TH, Jung SM, Chu YC, Wong HF. Concomitant spinal dural arteriovenous fistula and nodular fasciitis in an adolescent: case report. BMC Pediatr 2022; 22:30. [PMID: 34998361 PMCID: PMC8742378 DOI: 10.1186/s12887-021-03032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Spinal dural arteriovenous fistula (SDAVF) usually occurs during the 4th to 6th decades of life, and adolescent SDAVF is rarely reported. SDAVF arising around a tumor is also rare, and reported tumors are mostly schwannoma and lipoma. Case presentation We reported a 16-year-old male presented with progressive weakness and numbness of lower limbs for 3 months. A SDAVF was found, which was fed by right radicular arteries from segmental artery at L2 level and drained retrogradely into perimedullary veins. A concomitant spinal extradural nodular fasciitis at right L1/L2 intervertebral foramen was also noted. The SDAVF was completely obliterated by endovascular treatment and the tumor was debulked. The patient recovered well after the procedures. Conclusions Our case report suggests SDAVF can occur in adolescent. The concomitant presence with a nodular fasciitis indicates that although it usually arises in subcutaneous tissue but can rarely form on the dura of spine.
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Affiliation(s)
- Chan-Lin Chu
- Department of Neurology, New Taipei Municipal Tucheng Hospital, Chang Gung Memorial Hospital, New Taipei City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jen Lu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ming Jung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pathology, Linkou Chang-Gung Children Hospital, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Cheng Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Critical Care, Far-Eastern Hospital, New Taipei City, Taiwan
| | - Ho-Fai Wong
- Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang-Gung Memorial Hospital, No.5, Fuxing Street, Guishan Township, Taoyuan, Taiwan.
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11
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Wakely PE. Giant cell tumor of soft tissue: FNA cytopathology of 4 cases, review of the literature, and comparison with giant cell tumor of bone. Cancer Cytopathol 2021; 130:120-127. [PMID: 34618411 DOI: 10.1002/cncy.22517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The cytopathology of a giant cell tumor of soft tissue (GCT-ST), a fibrohistiocytic neoplasm distinct from other giant cell-rich soft tissue tumors, is rarely reported. The authors report their experience with a series of 4 GCT-ST fine-needle aspiration (FNA) biopsy cases and compare them with a set from giant cell tumors of bone (GCTBs). METHODS The authors' cytopathology files were searched for GCT-ST examples with histopathologic confirmation. FNA biopsy smears were performed and examined with standard techniques. RESULTS Four cases of GCT-ST presenting as a primary soft tissue mass from 4 patients (3 males and 1 female; age range, 28-75 years, mean age, 53 years) were retrieved. FNA sites included the anterior tibia, buttock, shoulder, and upper back. Three cases were interpreted as suspicious for sarcoma radiographically. The specific diagnoses were atypical giant cell tumor of tendon sheath, suspicious for GCT-ST, atypical myxoid lesion with giant cells, and benign with osteoclast-like giant cells (OLGCs). No case was interpreted as malignant. Aspirates consisted of mononuclear polygonal cells, spindled fibroblast cell clusters, and large OLGCs to the near exclusion of other cell types. OLGCs possessed 10 or more nuclei per cell. A comparison with GCTB aspirates and single case reports from the literature showed comparable cytomorphology. CONCLUSIONS GCT-ST FNA smears mimic those of GCTBs containing a limited population of uniform spindle cell clusters, single dispersed polygonal cells, and cytologically banal OLGCs. GCT-ST should be considered in the differential diagnosis of aspirates containing numerous osteoclast-like giant cells.
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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12
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Massarelli M, Paparo F, Benedetti S. A rare case of maxillary nodular fasciitis: Case report and short literature review. Clin Case Rep 2021; 9:31-33. [PMID: 33505683 PMCID: PMC7813115 DOI: 10.1002/ccr3.3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/08/2022] Open
Abstract
Nodular fasciitis has to be considered as an option in the presence of a solitary, rapidly growing mass even in older adults. When possible, direct surgery should be preferred to FNAC, particularly in the older adults because of high misdiagnostic risk.
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Affiliation(s)
- Mauro Massarelli
- Department of Maxillo‐Facial SurgeryAzienda Ospedaliera S.MariaTerniItaly
| | - Francesco Paparo
- Department of Maxillo‐Facial SurgeryAzienda Ospedaliera S.MariaTerniItaly
| | - Simone Benedetti
- Department of Maxillo‐Facial SurgeryAzienda Ospedaliera S.MariaTerniItaly
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13
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Wu SY, Zhao J, Chen HY, Hu MM, Zheng YY, Min JK, Yu RS. MR imaging features and a redefinition of the classification system for nodular fasciitis. Medicine (Baltimore) 2020; 99:e22906. [PMID: 33157932 PMCID: PMC7647516 DOI: 10.1097/md.0000000000022906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To analyze magnetic resonance imaging features of nodular fasciitis and redefine the system for classifying this class of lesions.Twenty-seven patients with nodular fasciitis and 71 patients with other soft tissue lesions who underwent surgery or biopsy were retrospectively analysed. Demographic information, medical history, and magnetic resonance imaging features were collected. Classification of nodular fasciitis was performed based on a redefined system. Comparison between 2 groups was performed with Chi-square or Fisher exact test.For nodular fasciitis, the longest average lesion diameter was 1.87 cm (range, 0.52-5.46 cm), and 40.7% of lesions were located in the upper extremities, while 29.6% were located in the head and neck. Compared with skeletal muscle, most lesions exhibited isointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging, and 45.5% of the lesions exhibited rim enhancement, 40.9% showed obvious homogenous enhancement, while 13.6% showed no enhancement or slight enhancement. The subcutaneous type accounted for 25.9% of cases, the fascial type 25.9%, the intramuscular type 29.6%, and the unclassified type 18.5%. The "fascia tail sign" was more frequently observed in nodular fasciitis than in other soft tissue lesions (P < .001). Nodular fasciitis was slightly more likely to present with the "inverted target sign" and "solar halo sign" than other soft tissue lesions (P > .05). The "cloud sign" only appeared in nodular fasciitis (P < .05).The "fascia tail sign" and "cloud sign" could help differentiate nodular fasciitis from other soft tissue lesions. A new classification may improve understanding about nodular fasciitis.
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Affiliation(s)
- Shi-Yong Wu
- Department of Radiology, The First Affiliated Hospital of Huzhou University, Huzhou
| | - Jin Zhao
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Hai-Yan Chen
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Miao-Miao Hu
- Department of Radiology, The First Affiliated Hospital of Huzhou University, Huzhou
| | - Yin-Yuan Zheng
- Department of Radiology, The First Affiliated Hospital of Huzhou University, Huzhou
| | - Ji-Kang Min
- Department of Orthopedics, The First Affiliated Hospital of Huzhou University, Huzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
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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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15
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Rekhi B, Ramadwar M. Cytomorphological features of an unusual case of a multifocal pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma in a young adult male. Diagn Cytopathol 2020; 49:E106-E112. [PMID: 32886445 DOI: 10.1002/dc.24606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022]
Abstract
Pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma (PMHE) is a relatively newly described vascular neoplasm, characterized by distinct clinicopathological and molecular features, with no report on its cytomorphological features on smears, till date. A 17-year-old male presented with multiple nodules on his left upper limb. Radiologic imaging disclosed multiple lesions involving the soft tissues, skin, and bones of his left upper limb. Biopsy of one of the lesions on his left ring finger revealed a cellular tumor comprising plump spindle and epithelioid cells, containing moderate to abundant, eosinophilic cytoplasm; mild nuclear atypia, vesicular nuclear chromatin, discernible nucleoli, infrequent mitotic figures, and interspersed neutrophils. Immunohistochemically, tumor cells were positive for AE1/AE3, CD31, and FLI-1, while negative for CD34 and desmin. INI1/SMARCB1 was retained. MIB1/Ki67 highlighted nearly 3% tumor cells (low). Diagnosis of a PMHE was offered. A simultaneous fine needle aspiration cytology smears of the lesions in his left forearm and ipsilateral axillary region revealed spindle and some polygonal shaped cells, arranged in tight and loose clusters, as well as scattered singly, containing abundant cytoplasm with tapering cell membranes, at places; vesicular nuclear chromatin and characteristic intercellular fibrillary stromal material. The present case constitutes the first report on cytomorphological features of a PMHE, diagnosed on cytology, including its differential diagnoses, immunohistochemical features with molecular updates.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Mukta Ramadwar
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI) University, Mumbai, India
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16
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Allison DB, Smith AP, An D, Miller JA, Shafique K, Song S, Viswanathan K, Eykman E, Rao RA, Wiles A, Barkan GA, Nayar R, Fadda G, Powers CN, Rossi ED, Siddiqui MT, Ali SZ, Kholová I, Layfield LJ, Field A, Baloch Z, Maleki Z. Assessing the diagnostic accuracy for pleomorphic adenoma and Warthin tumor by employing the Milan System for Reporting Salivary Gland Cytopathology: An international, multi-institutional study. Cancer Cytopathol 2020; 129:43-52. [PMID: 32767837 DOI: 10.1002/cncy.22339] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has established distinct diagnostic categories for reporting cytopathological findings, and each is associated with a defined risk of malignancy (ROM). However, the ROM is applied at the overall category level and is not specific for particular morphological entities within a category. Here, the diagnostic performance of the MSRSGC for pleomorphic adenoma (PA) and Warthin tumor (WT) is reported. METHODS The pathology archives of 11 institutions from 4 countries were retrospectively searched to identify all salivary gland fine-needle aspiration (FNA) biopsies with a differential or definitive diagnosis of PA or WT and all resection specimens with a diagnosis of PA or WT; only paired cases were included. All FNA diagnoses were retrospectively classified according to the MSRSGC. RESULTS A total of 1250 cases met the inclusion criteria, and they included 898 PA cases and 352 WT cases. The ROM in the benign neoplasm category was 3.0% and 1.3% for cases with a differential or definitive diagnosis of PA and WT, respectively. The ROM in the salivary gland neoplasm with uncertain malignant potential (SUMP) category was 2.7% and 18.8% for PA and WT, respectively (P = .0277). The diagnostic accuracy for PA and WT was 95.1% and 96.1%, respectively. CONCLUSIONS The diagnostic accuracy for PA and WT on FNA is high. Furthermore, these findings highlight the difference in the ROMs associated with 2 specific differential diagnoses in the SUMP category: basaloid neoplasms and oncocytoid neoplasms.
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Affiliation(s)
- Derek B Allison
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Alexander P Smith
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Daniel An
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - James Adam Miller
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Khurram Shafique
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sharon Song
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kartik Viswanathan
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, New York
| | - Elizabeth Eykman
- Department of Pathology, St. Vincent Hospital, Sydney, New South Wales, Australia
| | - Rema A Rao
- Department of Pathology, Montefiore Medical Center, Bronx, New York
| | - Austin Wiles
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Ritu Nayar
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Guido Fadda
- Department of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Celeste N Powers
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, New York
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lester J Layfield
- Department of Pathology, University of Missouri School of Medicine, Columbia, Missouri
| | - Andrew Field
- Department of Pathology, St. Vincent Hospital, Sydney, New South Wales, Australia
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
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17
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Kitagawa Y, Tsunoda R, Nanno M, Arai S, Takai S. Combined Use of Magnetic Resonance Imaging and Fine-Needle Aspiration Cytology for Diagnosis of Soft-Tissue Tumors. J NIPPON MED SCH 2020; 87:54-59. [DOI: 10.1272/jnms.jnms.2020_87-201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Ryu Tsunoda
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School Tama Nagayama Hospital
| | - Satoru Arai
- Department of Pathology, Nippon Medical School Tama Nagayama Hospital
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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18
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Jebastin Thangaiah J, Vickery J, Selwanes W, Al-Haddad E, Perry KD, Palanisamy N, Poulik JM, Williamson SR, Chitale DA, Shehata BM. A Novel COL1A1-CAMTA1 Rearrangement in Cranial Fasciitis. Int J Surg Pathol 2020; 28:678-682. [PMID: 32192385 DOI: 10.1177/1066896920912485] [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] [Indexed: 11/15/2022]
Abstract
Cranial fasciitis is an uncommon benign fibroblastic tumor, generally histologically identical to nodular fasciitis. It develops almost exclusively in children. Cranial fasciitis manifests clinically as a painless rapidly growing solitary nodule in the head and neck area, frequently eroding the underlying bone. Thus, this entity is often confused with aggressive lesions such as sarcomas, both clinically and radiologically. Histopathologic examination is essential to differentiate between cranial fasciitis and fibrohistiocytic or even sarcomatous lesions observed in children. In this article, we present a case of cranial fasciitis with intracranial extension in a 2-year-old boy. Although USP6 rearrangement has recently been recognized as a recurring alteration in nodular fasciitis, we present a novel COL1A1-CAMTA1 fusion in this lesion.
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Affiliation(s)
| | | | | | | | | | | | | | - Sean R Williamson
- Henry Ford Health System, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
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19
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Mustafa S, VandenBussche CJ, Ali SZ, Siddiqui MT, Wakely PE. Cytomorphologic findings of low-grade fibromyxoid sarcoma. J Am Soc Cytopathol 2020; 9:191-201. [PMID: 32197967 DOI: 10.1016/j.jasc.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Low-grade fibromyxoid sarcoma (LGFMS) is a rare fibroblastic tumor characterized by a prolonged clinical course and malignant biological behavior. Given its deceptively bland cytomorphology, a diagnosis can be quite challenging notably on fine-needle aspiration (FNA). In an attempt to shed light on some of the distinctive cytomorphologic characteristics, this study was conducted to review all cases of LGFMS in our database, correlating available clinical data, immunohistochemical findings, and molecular analysis. MATERIALS AND METHODS This series included 20 FNAs from 18 patients with a histologically confirmed LGFMS diagnosis from 3 large academic institutions. Detailed cytomorphologic analysis for each case was documented in conjunction with corresponding clinical characteristics and provided ancillary testing. RESULTS Out of 14 adequate FNA samples, 9 (64.2%) demonstrated a mixture of fibrous and myxoid pattern; the majority of cases were composed of deceptively bland tumor cells with rare nuclear pleomorphism and nuclear membrane irregularities. A MUC4 immunostain was performed on 5 specimens; all tested positive (100%). FUS rearrangement was detected in 4 out of 5 cases (80%). Follow-up information revealed 5-year recurrence in 1 case and metastatic disease in 2 cases, to the lung/pleura (8 years) and fourth rib (1 year), respectively. CONCLUSIONS The presence of bland spindle cells and associated with myxoid matrix material, in the appropriate clinical setting, can suggest LGFMS and direct additional confirmatory testing. A definitive diagnosis of LGFMS on FNA requires adequate sampling, familiarity with key cytomorphologic features, acquisition of diagnostic material for a cell block preparation and ancillary testing, and clinicoradiologic correlation.
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Affiliation(s)
- Sara Mustafa
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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20
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Rani D, Gupta A. Cytological Diagnosis and Misdiagnosis of Nodular Fasciitis. J Cytol 2019; 36:196-199. [PMID: 31741577 PMCID: PMC6844020 DOI: 10.4103/joc.joc_112_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/04/2022] Open
Abstract
Background Nodular fasciitis (NF) is a rapidly growing, self-limiting, subcutaneous nodular cytologic exuberant fibroblastic/myofibroblastic proliferation prone to cytological misdiagnosis. Aims This study aimed at finding out the utility of fine needle aspiration cytology (FNAC) from NF patients and to validate the diagnostic features. Materials and Methods The study group comprised 11 cases diagnosed as NF on cytology or subsequent histology. Results Out of 11 cases, 9 were cytologically diagnosed as NF. Two cases were misdiagnosed as sarcoma as proven histologically. Of the 9 cases of NF, spontaneous resolution occurred in 7 cases in 2-16 weeks; excisional biopsy was undertaken in the other 2 cases. Conclusion On cytology, NF reveals hypercellular, polymorphic, dispersed cell population, which is most commonly misdiagnosed as sarcoma. For this reason, FNAC has to be correlated with clinical data and followed up for the anticipated spontaneous regression.
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Affiliation(s)
- Deepa Rani
- Department of Pathology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
| | - Arsh Gupta
- Department of Pathology, Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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21
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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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22
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Dowling EM, Moore EJ. Nodular Fasciitis Mimicking Pleomorphic Adenoma. EAR, NOSE & THROAT JOURNAL 2019; 99:363-364. [PMID: 31064246 DOI: 10.1177/0145561319849010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eric M Dowling
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
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23
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Díaz Del Arco C, Ortega Medina L, Fernández Aceñero MJ. The role of fine-needle aspiration cytology in the diagnosis of soft tissue nodules: Experience in a tertiary center. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 52:147-153. [PMID: 31213255 DOI: 10.1016/j.patol.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/13/2018] [Accepted: 10/20/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Excisional or core needle biopsy is considered the gold standard for diagnosing soft tissue lesions (STL). However, the role of fine-needle aspiration cytology (FNAC) in STL remains controversial. MATERIALS AND METHODS We have reviewed 234 FNAC of STL diagnosed in our institution with the aim of analyzing the reliability of FNAC in STL. Cytological diagnoses were classified into groups and correlated with histological diagnoses. We have also reviewed the literature and compared our results with those previously reported. RESULTS The majority of patients were male (53.4%) and mean age was 61 years. Lesions were mainly located in the head and neck region. Inadequate material was obtained in 22.6% of cases and most lesions were inflammatory lesions or benign soft tissue tumors. Carcinoma and benign soft tissue tumor were the most frequent cytological diagnoses. Biopsy was performed in 36.1% of cases, and carcinoma was detected in 33.3% of inflammatory FNACs. General and specific concordances were 65.9% and 47.1%. Diagnostic sensitivity, specificity, negative and positive predictive values were 71.4%, 100%, 85.7% and 93.8%, respectively. CONCLUSIONS FNAC of STL is a valuable tool for diagnosing benign epithelial cysts, carcinomas, hematolymphoid neoplasms and benign soft tissue tumors. Inflammatory smears may be associated with false-negative cases. The availability of a multidisciplinary team, clinical and imaging features, ROSE and immunohistochemical and molecular techniques is required for improving the role of FNAC of STL.
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Affiliation(s)
| | - Luis Ortega Medina
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
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24
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Allison DB, Rooper LM, Mustafa S, Maleki Z, Wakely PE, Ali SZ. Cytopathologic characteristics of HPV-related small cell carcinoma of the oropharynx. Cancer Cytopathol 2018; 127:35-43. [PMID: 30468701 DOI: 10.1002/cncy.22078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/19/2018] [Accepted: 10/04/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Human papillomavirus (HPV)-related squamous cell carcinoma (SqCC) of the oropharynx is an epidemiologically and clinically distinct form of SqCC that is associated with an improved prognosis. However, HPV-related small cell carcinoma of the oropharynx is a rare and newly described variant that is associated with aggressive clinical behavior and poor outcomes. To date, fewer than 2 dozen reports of this entity exist in the literature, and there is no discussion of cytopathologic features. This article reports 6 cases and discusses the salient cytomorphologic findings, ancillary studies, and challenges when this entity is encountered. METHODS Anatomic pathology archives were searched to identify patients with a diagnosis of HPV-related small cell carcinoma of the oropharynx. Medical records were reviewed to document the following: age, sex, smoking status, other relevant clinical history, primary location, treatment, and clinical outcome. Both p16 and high-risk HPV in situ hybridization (ISH) studies were positive in at least 1 specimen from each patient. The pathologic diagnoses, cytomorphologic characteristics, immunocytochemical stains, and HPV ISH studies were reviewed and recorded for all available cases. RESULTS Six patients with 11 cytopathology specimens of HPV-related small cell carcinoma of the oropharynx were identified. The mean age was 61.3 years, and all patients died with widely metastatic disease (mean, 23 months; range, 12-48 months). Mixed small cell carcinoma and SqCC components were present in half of the cases. CONCLUSIONS The identification of a small cell component can be reliably performed with cytology preparations and is crucial because this (and not the HPV status) determines the prognosis.
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Affiliation(s)
- Derek B Allison
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara Mustafa
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul E Wakely
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Syed Z Ali
- Department of Pathology and Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Allison DB, VandenBussche CJ, Rooper LM, Wakely PE, Rossi ED, Faquin WC, Ali SZ. Nodular fasciitis of the parotid gland: A challenging diagnosis on FNA. Cancer Cytopathol 2018; 126:872-880. [DOI: 10.1002/cncy.22049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/17/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Derek B. Allison
- Department of Pathology Johns Hopkins University School of Medicine, Johns Hopkins Hospital Baltimore Maryland
| | - Christopher J. VandenBussche
- Department of Pathology Johns Hopkins University School of Medicine, Johns Hopkins Hospital Baltimore Maryland
- Department of Oncology Johns Hopkins University School of Medicine, Johns Hopkins Hospital Baltimore Maryland
| | - Lisa M. Rooper
- Department of Pathology Johns Hopkins University School of Medicine, Johns Hopkins Hospital Baltimore Maryland
- Department of Oncology Johns Hopkins University School of Medicine, Johns Hopkins Hospital Baltimore Maryland
| | - Paul E. Wakely
- Department of Pathology Ohio State University Wexner Medical Center Columbus Ohio
| | - Esther D. Rossi
- Department of Anatomic Pathology and Histology University of the Sacred Heart Rome Italy
| | - William C. Faquin
- Department of Pathology, Harvard Medical School Massachusetts General Hospital Boston Massachusetts
| | - Syed Z. Ali
- Department of Pathology Johns Hopkins University School of Medicine, Johns Hopkins Hospital Baltimore Maryland
- Department of Radiology Johns Hopkins University School of Medicine, Johns Hopkins Hospital Baltimore Maryland
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