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Klijanienko J, Masliah-Planchon J, Choussy O, Rougier G, Vautrin AD, Lesnik M, Badois N, Ghanem W, Klos J, Le Tourneau C, Marret G, Barnhill R, El-Naggar AK. Is Primary Poorly Differentiated Sarcomatoid Malignancy of the Parotid Gland Sarcomatoid Undifferentiated/Dedifferentiated Melanoma? Report of Three Unusual Cases Diagnosed by Fine-Needle Aspiration Combined with Histological, Immunohistochemical, and Molecular Analyses. Acta Cytol 2024; 68:107-120. [PMID: 38437817 DOI: 10.1159/000538070] [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: 11/17/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Poorly differentiated primary sarcomatoid parotid malignancies are extremely rare. These tumors have not been consistently studied by morphology, immunohistochemistry, or molecular techniques. CASE PRESENTATION We report three unusual cases of parotid gland poorly-differentiated sarcomatoid malignancy investigated by fine-needle aspiration and studied histologically, by immunohistochemistry and molecular investigations. Aspirates showed poorly specific polymorphous sarcomatoid malignancy in all cases. Histologically, all cases were polymorphous high-grade malignancies, and additionally, one case showed epithelial structures and was finally classified as salivary carcinosarcoma. Immunohistochemistry showed classical melanocytic markers negativity but positivity for PRAME, CD10, and WT1 in all three tumors and for CD56 in two tumors, which can potentially be supportive of melanocytic origin. Although not entirely specific, molecular characterization also suggested the melanocytic lineage of these tumors. CONCLUSION Although rare, primary malignant melanoma of salivary gland was already described, but undifferentiated/dedifferentiated amelanotic forms are unknown in this localization up today. Further case reports of similar presentations are required to confirm the unequivocal primary origin of these obscure neoplasms in the parotid gland.
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Affiliation(s)
- Jerzy Klijanienko
- Department of Pathology and Theranostics, Institut Curie, Paris, France
| | | | - Olivier Choussy
- Department of Head and Neck Surgery, Institut Curie, Paris, France
| | | | | | - Maria Lesnik
- Department of Head and Neck Surgery, Institut Curie, Paris, France
| | - Nathalie Badois
- Department of Head and Neck Surgery, Institut Curie, Paris, France
| | - Wahib Ghanem
- Department of Head and Neck Surgery, Institut Curie, Paris, France
| | - Jan Klos
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | | | - Gregoire Marret
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Raymond Barnhill
- Department of Pathology and Theranostics, Institut Curie, Paris, France
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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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Wang CW, Muzakky H, Lee YC, Lin YJ, Chao TK. Annotation-Free Deep Learning-Based Prediction of Thyroid Molecular Cancer Biomarker BRAF (V600E) from Cytological Slides. Int J Mol Sci 2023; 24:ijms24032521. [PMID: 36768841 PMCID: PMC9916807 DOI: 10.3390/ijms24032521] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Thyroid cancer is the most common endocrine cancer. Papillary thyroid cancer (PTC) is the most prevalent form of malignancy among all thyroid cancers arising from follicular cells. Fine needle aspiration cytology (FNAC) is a non-invasive method regarded as the most cost-effective and accurate diagnostic method of choice in diagnosing PTC. Identification of BRAF (V600E) mutation in thyroid neoplasia may be beneficial because it is specific for malignancy, implies a worse prognosis, and is the target for selective BRAF inhibitors. To the authors' best knowledge, this is the first automated precision oncology framework effectively predict BRAF (V600E) immunostaining result in thyroidectomy specimen directly from Papanicolaou-stained thyroid fine-needle aspiration cytology and ThinPrep cytological slides, which is helpful for novel targeted therapies and prognosis prediction. The proposed deep learning (DL) framework is evaluated on a dataset of 118 whole slide images. The results show that the proposed DL-based technique achieves an accuracy of 87%, a precision of 94%, a sensitivity of 91%, a specificity of 71% and a mean of sensitivity and specificity at 81% and outperformed three state-of-the-art deep learning approaches. This study demonstrates the feasibility of DL-based prediction of critical molecular features in cytological slides, which not only aid in accurate diagnosis but also provide useful information in guiding clinical decision-making in patients with thyroid cancer. With the accumulation of data and the continuous advancement of technology, the performance of DL systems is expected to be improved in the near future. Therefore, we expect that DL can provide a cost-effective and time-effective alternative tool for patients in the era of precision oncology.
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Affiliation(s)
- Ching-Wei Wang
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 106335, Taiwan
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106335, Taiwan
| | - Hikam Muzakky
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 106335, Taiwan
| | - Yu-Ching Lee
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106335, Taiwan
| | - Yi-Jia Lin
- Department of Pathology, Tri-Service General Hospital, Taipei 106335, Taiwan
- Institute of Pathology and Parasitology, National Defense Medical Center, Taipei 106335, Taiwan
| | - Tai-Kuang Chao
- Department of Pathology, Tri-Service General Hospital, Taipei 106335, Taiwan
- Institute of Pathology and Parasitology, National Defense Medical Center, Taipei 106335, Taiwan
- Correspondence:
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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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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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Sakuma T, Mori M, Kokubo C, Matsumoto Y. Imprint cytology for a subcutaneous tumour. Cytopathology 2020; 31:483-486. [PMID: 32171030 DOI: 10.1111/cyt.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/10/2020] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Takahiko Sakuma
- Department of Laboratory Medicine, Atsumi Hospital, Tahara, Aichi, Japan
| | - Mikiko Mori
- Department of Laboratory Medicine, Atsumi Hospital, Tahara, Aichi, Japan
| | - Chikako Kokubo
- Department of Laboratory Medicine, Atsumi Hospital, Tahara, Aichi, Japan
| | - Yusuke Matsumoto
- Department of Orthopaedics, Atsumi Hospital, Tahara, Aichi, Japan
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Li W, Molnar SL, Mott M, White E, De Las Casas LE. Superficial CD34-positive fibroblastic tumor: Cytologic features, tissue correlation, ancillary studies, and differential diagnosis of a recently described soft tissue neoplasm. Diagn Cytopathol 2016; 44:926-930. [PMID: 27432164 DOI: 10.1002/dc.23529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/15/2016] [Accepted: 06/24/2016] [Indexed: 12/15/2022]
Abstract
Superficial CD34-positive fibroblastic tumor is a low-grade mesenchymal neoplasm of superficial soft tissues characterized by fascicles of spindle to epithelioid cells displaying nuclear pleomorphism and strong diffuse CD34 immunoreactivity. The intraoperative imprint cytology preparations (ICP) of a superficial CD34-positive fibroblastic tumor from a 50-year-old female are described. To the best of our knowledge, there is no report of the cytologic findings of superficial CD34-positive fibroblastic tumor in the English medical literature. The ICP, differential diagnosis, tissue correlation, and ancillary studies of this fascinating entity are discussed. Diagn. Cytopathol. 2016;44:926-930. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Weihong Li
- Department of Pathology, University of Toledo Medical Center, Toledo, Ohio
| | - Stacy L Molnar
- Department of Pathology, University of Toledo Medical Center, Toledo, Ohio
| | - Michael Mott
- Henry Ford Hospital, Orthopedic Oncology, Detroit, Michigan
| | - Erik White
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Luis E De Las Casas
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
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Ogun GO. Fine needle Aspiration Biopsy (FNAB) in the initial evaluation and diagnosis of palpable soft tissue lesions and with histologic correlation. Pan Afr Med J 2015; 20:44. [PMID: 26090002 PMCID: PMC4449991 DOI: 10.11604/pamj.2015.20.44.4271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 01/13/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Fine-needle aspiration biopsy (FNAB) as a means of evaluation of palpable soft tissue lesions is poorly utilized in our environment despite the fact that it safe, cheap, quick and easy to perform. Methods All cases of cases of palpable soft tissue lesions of the trunk and extremities where FNAB was used as the initial evaluation tool were reviewed. Furthermore, the records for corresponding cases that had open excision biopsy and ultimately had histologic diagnosis out of these cases were also retrieved and correlated with the final diagnosis from FNAB. Results Out of 142 aspirates, only 107(75.3% of cases) fulfilled the inclusion criteria for the study. The age range was from 0-85 years (mean = 41.2 yrs.) with a roughly equal male:female ratio. The lesions were located in the trunk -56 cases, upper arm -7, forearm -1, hand -1, thigh -28, leg -7 and the foot-7. The FNAB was diagnosed as benign in 56 (52.3%) cases, malignant in 48 (44.8%) cases and suspicious of malignancy in 3(2.8%) cases. The cases were cytomorphologically classified into the following categories: Lipomatous (32 cases), epithelia (18), spindle cell (14), inflammatory (13) pleomorphic (11), small round (6), myxoid (5), epitheloid/ polygonal (1) and others (7). The sensitivity and specificity of diagnosed cases with FNAB as either benign or malignant when correlated with histology were 95% and 100% respectively. Conclusion FNAB is a valuable tool in the initial evaluation of palpable soft tissue lesions especially in primary soft tissue neoplasms and clinically suspected metastatic carcinomas.
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Affiliation(s)
- Gabriel Olabiyi Ogun
- Department of Pathology, College of Medicine, University of Ibadan/ University College Hospital, Ibadan, Nigeria
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Klijanienko J, Pierron G, Sastre-Garau X, Theocharis S. Value of combined cytology and molecular information in the diagnosis of soft tissue tumors. Cancer Cytopathol 2014; 123:141-51. [DOI: 10.1002/cncy.21496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gaelle Pierron
- Department of Tumor Biology; Curie Institute; Paris France
| | | | - Stamatios Theocharis
- Department of Tumor Biology; Curie Institute; Paris France
- First Department, Department of Pathology; Medical School; University of Athens; Athens Greece
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Lima PMDA, Oliveira MP, Ferreira GR, Lima TPDM, Lima JDA, Mello RJVD. Effectiveness of histology and cytology on musculoskeletal tumor diagnosis. ACTA ORTOPEDICA BRASILEIRA 2014; 22:132-5. [PMID: 25061418 PMCID: PMC4108694 DOI: 10.1590/1413-78522014220300440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/16/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To compare cytology and histology on the diagnosis of musculoskeletal neoplasms. METHOD: Fifty eight cases available to evaluation were analyzed both by cytology and histology. The results of the biopsies studied by histology and cytology were compared to the results obtained on the surgical specimen or immunohistochemistry. We determined the percentage of correct results, sensitivity, specificity, positive and negative predictive values and accuracy of each method. RESULTS: Twelve per cent of biopsies were inconclusive by cytology. The percentage of correct diagnosis was 70.7% and 81% (p=.179), the ability to differentiate benign lesions from malignant ones was 84.5% and 93.1% (p=0.18) respectively, for cytology and histology. Cytology showed sensitivity of 87.8%, specificity of 76.5%, positive predictive value of 90%, negative predictive value of 72% and accuracy 84.5%. Histology showed sensitivity of 90.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 81% and accuracy of 93.1%. The Youden index for cytology was 64.3% and for histology it was 90.2%. CONCLUSION: Despite promising, cytology obtained by thin needle aspiration is less accurate and reliable than the histological evaluation on musculoskeletal tumors diagnosis. Level of Evidence II, Diagnostic Studies.
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Lima PMDA, Oliveira MP, Silva HJD, Mello RJVD. The role of cytology in the diagnosis of musculoskeletal neoplasms: systematic review. ACTA ORTOPEDICA BRASILEIRA 2014; 20:48-52. [PMID: 24453581 PMCID: PMC3718411 DOI: 10.1590/s1413-78522012000100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 04/02/2011] [Indexed: 12/14/2022]
Abstract
The authors systematically reviewed the literature of the last decade on the role of
cytology in the evaluation of musculoskeletal neoplasms, and its diagnostic accuracy. A
search was carried out on the databases PubMed, MEDLINE, LILACS and SciELO, selecting
articles in which cytology was used in the diagnosis of musculoskeletal neoplasms. Limits
were used for English, Spanish and Portuguese, and only articles published since 2000 were
selected. 757 articles were retrieved, 24 of which were selected based on criteria of
inclusion and exclusion. It was concluded that although promising in the assessment of
musculoskeletal neoplasms, cytology obtained by fine needle aspiration is less accurate
and reliable than histological evaluation of such lesions.
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Kasraeian S, Allison DC, Ahlmann ER, Fedenko AN, Menendez LR. A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res 2010; 468:2992-3002. [PMID: 20512437 PMCID: PMC2947686 DOI: 10.1007/s11999-010-1401-x] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biopsy tissue can be obtained through a fine needle, a wider coring needle, or through an open surgical incision. Though much literature exists regarding the diagnostic yield of these techniques individually, none compare accuracy of diagnosis in the same mass. QUESTIONS/PURPOSES We asked how the diagnostic accuracy of fine-needle aspiration, core biopsy, and open surgical biopsy compare in regard to identifying malignancy, establishing the exact diagnosis, and guiding the appropriate treatment of soft tissue masses. PATIENTS AND METHODS We prospectively studied 57 patients with palpable extremity soft tissue masses, performing fine-needle aspiration, followed by core biopsy, followed by surgical biopsy of the same mass. RESULTS Open surgical biopsy was 100% accurate on all accounts. With regard to determining malignancy, fine-needle aspiration and core biopsy had 79.17% and 79.2% sensitivity, 72.7% and 81.8% specificity, 67.9% and 76% positive predictive value, 82.8% and 84.4% negative predictive value, and an overall accuracy of 75.4% and 80.7%, respectively. In regard to determining exact diagnosis, fine-needle aspiration had a 33.3% accuracy and core biopsy had a 45.6% accuracy. With regard to eventual treatment, fine-needle aspiration was 38.6% accurate and core biopsy was 49.1% accurate. CONCLUSIONS In soft tissue mass diagnosis, core biopsy is more accurate than fine-needle aspiration on all accounts, and open biopsy is more accurate than both in determining malignancy, establishing the exact diagnosis, and the guiding appropriate treatment.
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Affiliation(s)
- Sina Kasraeian
- Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, 1200 N State St, Ste 3900, Los Angeles, CA USA
| | - Daniel C. Allison
- Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, 1200 N State St, Ste 3900, Los Angeles, CA USA
- Division of Musculoskeletal Oncology, Southern California Permanente Medical Group, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91706 USA
| | - Elke R. Ahlmann
- Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, 1200 N State St, Ste 3900, Los Angeles, CA USA
| | - Alexander N. Fedenko
- Department of Pathology, University of Southern California + Los Angeles County Medical Center, Los Angeles, CA USA
| | - Lawrence R. Menendez
- Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, USC University Hospital, Los Angeles, CA USA
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14
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15
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Colin P, Lagacé R, Caillaud JM, Sastre-Garau X, Klijanienko J. Fine-needle aspiration in myxofibrosarcoma: Experience of Institut Curie. Diagn Cytopathol 2009; 38:343-6. [DOI: 10.1002/dc.21206] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lingamfelter D, Chen Y, Kure K, Lankachandra K. Infiltrating myoepithelial carcinoma of the breast, a case report and cytologic-histologic correlation. Diagn Pathol 2008; 3:7. [PMID: 18261234 PMCID: PMC2257926 DOI: 10.1186/1746-1596-3-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 02/08/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Infiltrating myoepithelial carcinoma remains a rarely encountered lesion of the breast. The few cases that have surfaced firmly document the histopathology of this tumor, but its cytologic characteristics seemingly have been described in only one other report. Case presentation Here we present the cytologic findings from a case of infiltrating myoepithelial carcinoma of the breast in a 52-year-old female and provide a histologic correlation with the subsequent biopsy and mastectomy specimens. While the cytology specimens displayed more myoepithelial cellular heterogeneity than was present on histology, a number of cytologic features including hypercellularity, pleomorphic spindle cells, and mitotic activity correlated well with the histopathology. Conclusion The role of fine needle aspiration in the diagnosis of mammary myoepithelial carcinoma, in this case, was to establish malignancy rather than to arrive at a specific diagnosis, as a number of different entities potentially can mimic this neoplasm on cytologic specimens.
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Affiliation(s)
- Daniel Lingamfelter
- Department of Pathology, University of Missouri-Kansas City School of Medicine and Truman Medical Centers, Kansas City, Missouri, USA.
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Chang RC, Dave SP, Robinson PG. Undifferentiated pleomorphic sarcoma of the parotid gland: A rare pediatric case. Head Neck 2008; 30:970-3. [DOI: 10.1002/hed.20752] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Varma K, Mandal S, Jain S, Mandal AK. An ulcero proliferative growth in the gingiva: a cytological approach to the diagnosis. Cytopathology 2007; 18:376-9. [PMID: 18031449 DOI: 10.1111/j.1365-2303.2007.00488.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- K Varma
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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Nagano H, Deguchi K, Kurono Y. Malignant fibrous histiocytoma of the bucca: a case report. Auris Nasus Larynx 2007; 35:165-9. [PMID: 17888601 DOI: 10.1016/j.anl.2007.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/26/2006] [Accepted: 04/05/2007] [Indexed: 10/22/2022]
Abstract
Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma, but is relatively uncommon in head and neck area. Histologically, it is difficult to distinguish this tumor from other sarcomas and carcinomas. Surgery is the most reliable treatment for MFH, but the 5-year survival rate for cases of this tumor in the head and neck is low in comparison with MFH of the extremities and trunk. In the case reported here, the patient was a 61-year-old man who presented with swelling and pain of the left bucca. A CT scan demonstrated a 2.5 cm x 5.0 cm inhomogeneous lesion. In MRI, the tumor displayed an inhomogeneous isointense signal on T1-weighted images and a high-intensity signal on T2-weighted images. Fine-needle aspiration (FNA) was performed twice but we were unable to reach a definitive diagnosis histologically. MFH was subsequently diagnosed by open biopsy, and external radiotherapy with 38 Gy of radiation was performed. However, the tumor enlarged after this therapy, and therefore CyberKnife therapy was performed twice, after which the tumor gradually reduced in size. The patient is alive after a follow-up period of 22 months, and therefore we suggest that CyberKnife treatment may be useful for head and neck MFH.
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Affiliation(s)
- Hiromi Nagano
- Department of Otolaryngology, Ooshima Prefecture Hospital, 18-1 Manatu, Amami, Kagoshima 894-0015, Japan.
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Klijanienko J, Caillaud JM, Orbach D, Brisse H, Lagacé R, Sastre-Gareau X. Cyto-histological correlations inprimary, recurrent, and metastatic bone and soft tissue osteosarcoma. Institut Curie's experience. Diagn Cytopathol 2007; 35:270-5. [PMID: 17427216 DOI: 10.1002/dc.20562] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To determine diagnostic cytomorphologic features of osteosarcoma on fine-needle aspiration materials, we reviewed the cytologic material and corresponding histologic slides of 126 tumors in 107 patients. Fifty-five (43.6%) tumors were primary, 31 (24.6%) were recurrent, and 40 (31.8%) were metastatic. Review of original cytology reports revealed that 120 (95.3%) tumors were diagnosed as malignant. Six (4.7%) cases were reported as suspicious, false-negative, or unsatisfactory samples. Our findings showed that osteoblastic roundish cells, spindle-shaped cells, reactive giant cells, and osteoid were the most consistent features representative of osteosarcoma. Periosteal reactions, fractures with callous formation, giant cells of osteoclastic type in various conditions, chondrosarcoma with enchondral ossification are entities to consider in the differential diagnosis.
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Waterhouse DF, Cahill RA, Sheehan SJ. Malignant Fibrous Histiocytoma Masquerading as a Psuedoaneurysm of the Profunda Femoris. Eur J Vasc Endovasc Surg 2005; 30:267-9. [PMID: 15936228 DOI: 10.1016/j.ejvs.2005.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Accepted: 04/06/2005] [Indexed: 12/01/2022]
Abstract
We describe a patient with an aggressive soft tissue sarcoma masquerading as a profunda femoris pseudoaneurysm. A 73-year-old patient presented with a pulsatile swelling in her right groin. Femoral angiography demonstrated what appeared to be a pseudoaneurysm of the right profunda femoris artery and she underwent an open surgical repair. The patient represented 2 months later with an enlarging non-pulsatile, non-tender mass at the site of the wound. Open biopsy determined the diagnosis as malignant fibrous histiocytoma (MFH). An en bloc resection of the mass with reconstruction of the femoral artery and vein using PTFE grafts was performed.
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Affiliation(s)
- D F Waterhouse
- Department of Vascular Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Klijanienko J, Caillaud JM, Lagacé R. Fine-needle aspiration of primary and recurrent benign fibrous histiocytoma: classic, aneurysmal, and myxoid variants. Diagn Cytopathol 2005; 31:387-91. [PMID: 15540171 DOI: 10.1002/dc.20140] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a limited number of correlative cytopathological studies of fibrous histiocytoma (FHC). To better define cytopathological criteria of diagnosis, we have reviewed fine-needle aspirates (FNA) from 36 FHCs (32 classical, 1 myxoid, and 3 aneurysmal variants on corresponding histological sections). Original cytological diagnoses were benign in 33 (91.7%) cases (22 accurate) and false positive in 3 (8.3%) cases. All smears were surprisingly homogenous and composed of histiocytic cells with finely vacuolated cytoplasm in 27 (75%) cases, small regular spindle cells in 25 (69%) cases, and giant cells in 17 (47%) cases. Histiocytic cells were attached to vascular structures in 9 (25%) cases. Slight cytonuclear atypia was seen in five (14%) cases. Three (8.3%) cases showed numerous siderophages. In two (5.6%) cases, there were abundant inflammatory backgrounds and in one (3%) case there was a scant myxoid background. Storiform patterns, round cells, prominent atypia, necroses, or mitotic figures were not seen. FHC should be differentiated from other benign, low- and intermediate-grade spindle-cell neoplasms such as low-grade fibrosarcoma, dermatofibrosarcoma protuberans, nodular fasciitis, spindle-cell malignant melanoma, and monophasic synovial sarcoma. Some cases may be misinterpreted as malignant, especially in cases of recurrence or in patients with a cancer history.
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Lin O, Crapanzano JP. Fine-needle aspiration cytology of pleomorphic hyalinized angiectatic tumor: A case report. Diagn Cytopathol 2005; 32:238-42. [PMID: 15754361 DOI: 10.1002/dc.20219] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pleomorphic hyalinized angiectatic tumor (PHAT) of soft parts is a neoplasm characterized by spindle and pleomorphic cells associated with an angiectatic vasculature. We describe the cytological findings of a fine-needle aspiration biopsy (FNAB) from the right medial knee of a 45-yr-old woman. The aspirate material was entirely submitted in Cytolit solution. The specimen was moderately cellular and was comprised of spindle cells in a background of fibrinous material. The cells varied from small, bland spindle cells with a fine chromatin pattern and inconspicuous nucleoli to larger pleomorphic cells with coarser chromatin and occasional intranuclear inclusions. Most of the cells were arranged singly with sporadic small cluster formation with indistinct cell borders. Rare mononuclear inflammatory cells morphologically compatible with mast cells were identified. The differential diagnosis include solitary fibrous tumor (SFT) and ancient schwannoma, which also shows fibrous-like material and spindle cells that may have intranuclear inclusions.
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Affiliation(s)
- Oscar Lin
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
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Klijanienko J, Caillaud JM, Lagacé R. Fine-needle aspiration in liposarcoma: Cytohistologic correlative study including well-differentiated, myxoid, and pleomorphic variants. Diagn Cytopathol 2004; 30:307-12. [PMID: 15108227 DOI: 10.1002/dc.10424] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We have reviewed cytopathology and the corresponding histopathology material of 86 liposarcomas (55 patients) seen at Institut Curie. The liposarcomas (LS) were well differentiated in 14 cases (9 pure, 2 dedifferentiated, 3 sclerosing), 64 myxoid, and 8 pleomorphic. Twenty-four tumors were primary, 34 recurrent, and 28 secondary. Smears in LS were composed in different proportions of round, spindle cells, lipoblasts, and myxoid and vascular arborizing structures. Pure well-differentiated LS were frequently composed of lipoblasts, and round or spindle cells were occasionally seen. Dedifferentiated and sclerosing liposarcomas were composed of spindle or round cells, but lipoblasts were also occasionally present. Myxoid or vascular arborizing structures were absent. Myxoid LS (including round and spindle cell LS) frequently showed a myxoid background and less frequently vascular arborizing structures. Tumor cells were round or spindle. Lipoblasts were also seen. Pleomorphic LS were composed of an admixture of all cellular and stromal elements. Well-differentiated LS should be distinguished from hibernoma and spindle cell lipoma, and myxoid LS from myxoma, myxoid chondrosarcoma, chordoma, myxoid leiomyosarcoma, and myxoid malignant fibrous histiocytoma. The demonstration of the specific translocation t(12;16)(q13;p11) of myxoid LS is very helpful to establish the diagnosis. Pleomorphic LS should be differentiated from other high-grade sarcomas, whenever possible.
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Klijanienko J, Caillaud JM, Lagacé R. Fine-needle aspiration of primary and recurrent dermatofibrosarcoma protuberans. Diagn Cytopathol 2004; 30:261-5. [PMID: 15048962 DOI: 10.1002/dc.20024] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a nodular cutaneous mesenchymal tumor of intermediate malignancy. Studies on fine-needle aspiration of DFSP are extremely rare; to our knowledge, only 33 cases have been reported. We have reviewed 14 examples of DFSP in 13 patients. Ten primary tumors were aspirated before surgical biopsy and four recurrent lesions (all from superficial lesions) were also investigated by fine-needle aspiration. All smears were surprisingly homogeneous and composed of isolated spindle cells in all cases (one unsatisfactory smear is excluded). Tissue fragments with a stroriform pattern were seen in 11 cases, fibrillary stromal fragments in 10 cases, naked nuclei in 8 cases, slight to moderate cytonuclear atypia in 5 cases. Mitotic figures, myxoid background, mast cells, and dispersed adipocytes were rare. Giant cells, necrosis, or marked cytonuclear atypia were not seen. DFSP shares morphological characteristics of some low-grade spindle-cell neoplasms. It should be differentiated from other benign low- and intermediate-grade spindle neoplasm such as low-grade fibrosarcoma, fibromyxosarcoma, low-grade malignant peripheral nerve sheath tumor, benign peripheral nerve sheath tumor, nodular fasciitis, and fibrous histiocytoma.
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