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Dharmalingam P, MukundaPai M, Nargund A, Champaka G, Kavitha BL, Okaly GVP, Madhu SD, Arun Kumar AR. Doing More with Less: Fine Needle Aspiration Cytology in Pediatric Neoplasms. J Cytol 2021; 38:127-132. [PMID: 34703088 PMCID: PMC8489700 DOI: 10.4103/joc.joc_197_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 04/05/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Cancer is one of the leading causes of death in the pediatric age group following infections. Among the diagnostic modalities, fine needle aspiration cytology (FNAC) is increasingly recognized as it permits rapid diagnosis with low cost and complication. In this study, we emphasize the diagnostic value of FNAC and describe the cytomorphological spectrum of tumors diagnosed on FNAC in pediatric patients with or without the aid of ancillary tests. Materials and Methods: This retrospective study included a total of 614 patients under the age of 15 years for whom fine needle aspiration (FNA) was done during a period of 3 years with or without guidance. The cytology smears were reviewed, and the morphological spectrum was analyzed with the ancillary studies. Results: Aspirates from children constituted around 3.5% of the total FNAC performed in our Institute. Of the 614 cases, 336 were male, and 278 were female with age under 15 years. Neoplastic cases constituted around 72%, which included benign (2%) and malignant (98%) tumors. The spectrum include hematolymphoid neoplasms in 39.3%, small round cell tumors (SRCT) in 24.9%, Wilms tumor in 9.2%, germ cell tumors in 4.8%, spindle cell neoplasms in 4.8%, hepatoblastoma in 3.2%, and osteosarcoma in 3% of the cases. The metastatic lesions constituted 8.1% of the cases diagnosed by FNA. Conclusion: FNA proves to be a reliable and efficien modality in diagnosing pediatric neoplasms in the hands of a skilled cytopathologist.
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Affiliation(s)
- Priya Dharmalingam
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Malathi MukundaPai
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ashwini Nargund
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - G Champaka
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - B L Kavitha
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Geeta V Patil Okaly
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - S D Madhu
- Department of Radiology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - A R Arun Kumar
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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Gupta R, Sharma S, Verma S, Singh L, Gupta CR, Gupta S. Pediatric fine-needle aspiration cytology: An audit of 266 cases of pediatric tumors with cytologic-histologic correlation. Cytojournal 2020; 17:25. [PMID: 33273959 PMCID: PMC7708969 DOI: 10.25259/cytojournal_101_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/24/2020] [Indexed: 11/20/2022] Open
Abstract
Objectives: Fine-needle aspiration cytology (FNAC), a well-accepted minimally invasive diagnostic technique utilized in adults, is gradually gaining ground for pediatric patients as well. However, there are very few comprehensive reports in the literature on utility of FNA in pre-operative diagnosis of pediatric tumors. Material and Methods: An observational study was conducted at a cancer research center and a pediatric tertiary care hospital over a 5-year period. A cytologic-histologic correlation was performed for FNACs performed in pediatric patients for a clinical diagnosis of neoplastic lesions at both the centers. Relevant clinical details and histopathology, wherever available, were retrieved. Sensitivity, specificity, and accuracy of FNAC in diagnosis of malignant lesion were calculated from the cases with available histologic correlation. Results: Of the 266 cases included, there was a slight male predominance with lymphadenopathy being the most common presentation and non-Hodgkin’s lymphoma as the most frequent diagnosis in cases clinically suspected to have a neoplasm. Histologic correlation was available in 112 cases with 100% concordance in liver and kidney tumors. Few rare cytologic diagnoses such as papillary renal cell carcinoma, mesenchymal hamartoma of the liver, and thymolipoma could be accurately rendered on FNAC smears in conjunction with the clinic-radiologic features. The sensitivity, specificity, and accuracy of FNA in diagnosing malignant pediatric tumors were found to be 100%, 92.6%, and 97.7%, respectively. Conclusion: The present study underscores the high sensitivity and accuracy of FNAC in diagnosis of pediatric tumors, both in superficial and deep-seated locations. Awareness of the cytomorphologic features and clinic-radiologic correlation may assist the cytopathologists in rendering a precise diagnosis of rare pediatric tumors as well.
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Affiliation(s)
- Ruchika Gupta
- Department of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Sugandha Sharma
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Sarika Verma
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Lavleen Singh
- Department of Pathology, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Chhabi R Gupta
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Sanjay Gupta
- Department of Cytopathology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Shirian S, Daneshbod Y, Haghpanah S, Khademi B, Noorbakhsh F, Ghaemi A, Mosayebi Z. Spectrum of pediatric tumors diagnosed by fine-needle aspiration cytology. Medicine (Baltimore) 2017; 96:e5480. [PMID: 28178123 PMCID: PMC5312980 DOI: 10.1097/md.0000000000005480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pediatric tumors differ markedly from adult tumors in their nature, distribution, and prognosis. In this 10-year retrospective study, we present our experience with fine-needle aspiration (FNA) in pediatric patients 18 years of age and younger and correlate relationship between gender with organ, diagnosis, malignancy, and age. In our study, FNA material of pediatric tumors or masses with 18 years aged and younger were analyzed retrospectively.All FNAs in pediatric patients during this time period were identified and analyzed for age, gender, cytologic diagnosis, and site of aspiration. A total 1000 FNAs were performed from January 2007 to October 2015 in 499 children. Regardless the gender, the most frequently aspirated organ was lymph node, comprising 129 of the 499 cases followed by thyroid (112), neck cyst (79), and parotid (35) cases. The majority of the cases were diagnosed as benign lesions (436 of 499 cases). Other 63 cases comprising 40 female and 23 male cases had malignant lesions. There was significant age difference between people with or without malignancy. In malignant cases, there was a significant difference between the age on males and females. In regard to gender and diagnosis, cytologic diagnosis was stratified into 9 broad diagnostic categories: lymphadenitis, benign and malignant thyroid, cyst contents, benign breast, benign and malignant salivary, and negative for malignancy.In conclusion, our study supports the use of FNA cytology (FNAC) in lesions of various anatomic sites in the children less than 18 years old. As a simple, minimally invasive, and rapid procedure, cytopathologists can reliably utilize FNAC in children. The mean age of children receiving a malignant diagnosis was significantly higher than that of benign lesions. The mean age of malignancy in boys is significantly lower than that of girls with malignancy.
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Affiliation(s)
- Sadegh Shirian
- Department of Pathology, School of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
- Shiraz Molecular Pathology Research Center, Dr Daneshbod Pathology Lab, Shiraz, Iran
| | - Yahya Daneshbod
- Shiraz Molecular Pathology Research Center, Dr Daneshbod Pathology Lab, Shiraz, Iran
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bijan Khademi
- Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farshid Noorbakhsh
- Department of Immunology, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ghaemi
- Department of Virology, Pasteur Institute of Iran, Tehran, Iran
| | - Ziba Mosayebi
- Department of Pediatrics, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
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D'Anza B, Kraseman SJ, Canto-Helwig C, Greene JS, Wood WE. FNA biopsy of pediatric cervicofacial masses and validation of clinical characteristics of malignancy. Int J Pediatr Otorhinolaryngol 2015; 79:1196-200. [PMID: 26092550 DOI: 10.1016/j.ijporl.2015.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/06/2015] [Accepted: 05/09/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pediatric head and neck masses can pose a diagnostic challenge due to their ubiquitous nature. The vast majority of masses are inflammatory, however malignancies do occur. This study is a review of fine needle aspiration biopsy (FNA-B) as a diagnostic technique at a single institution over a 13 year period. The objectives were to examine the sensitivity and specificity of FNA-B, correlate these results with clinical characteristics of each mass and determine if such characteristics are associated with malignancy. METHODS This was a retrospective case series of 143 consecutive pediatric patients who underwent FNA-B of 146 head and neck masses with subsequent follow up examinations from 2000 to 2012 (inclusive). We expected FNA-B to be a sensitive and specific method for determining malignancy. FNA-B diagnoses were confirmed with open biopsy pathology results and clinical follow up greater than 1 year. Physical exam characteristics of each mass including location, tenderness, firmness, and mobility were documented. Chi square and Fisher exact tests were used to determine statistical significance. RESULTS The sensitivity and specificity of FNA-B in determining malignancy were 87.5% and 100% respectively. Positive and negative predictive values were 100% and 99.1%, respectively. On univariate analysis of clinical descriptors associated with malignancy, non-mobile masses significantly correlated (p=0.0025), while the firmness and tenderness of a mass did not reach statistical significance. Of mass locations, the lateral neck had the strongest association with malignancy, but this relationship only demonstrated statistical significance when lymphomas were considered independently (p=0.0428). CONCLUSIONS Results demonstrate FNA-B to be an effective method for the diagnosis of pediatric head and neck masses. It maintained a high sensitivity and specificity with a large sample size, to date one of the largest in the pediatric otolaryngology literature. Also, the data offered statistical validation of classical signs of malignancy and showed fixed masses to have the highest correlation. Finally, the findings support lateral neck masses to warrant a higher degree of suspicion for malignancy compared to other compartments.
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Affiliation(s)
- Brian D'Anza
- Geisinger Medical Center, Department of Otolaryngology, 100 N. Academy Ave., Danville, PA 17822, USA.
| | - Stephen J Kraseman
- Naperville Ear, Nose & Throat Associates, 10W. Martin Ave, No. 260, Naperville, IL 60540, USA
| | - Cecilia Canto-Helwig
- Geisinger Medical Center, Department of Otolaryngology, 100 N. Academy Ave., Danville, PA 17822, USA
| | - J Scott Greene
- Geisinger Medical Center, Department of Otolaryngology, 100 N. Academy Ave., Danville, PA 17822, USA
| | - W Edward Wood
- Geisinger Medical Center, Department of Otolaryngology, 100 N. Academy Ave., Danville, PA 17822, USA
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Lucci R, Vigliar E, Malapelle U, Cigliano B, Troncone G, Bellevicine C. Fine-needle aspiration findings in focal (nodular) myositis of a newborn: A case report. Diagn Cytopathol 2015; 43:920-3. [PMID: 26173198 DOI: 10.1002/dc.23309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 04/17/2015] [Accepted: 06/22/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Raffaella Lucci
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Malapelle
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Bruno Cigliano
- Pediatric Surgical Division, Department of Translational Medicine, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Claudio Bellevicine
- Pathology Division, Department of Public Health, University of Naples Federico II, Naples, Italy
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Snyder LA, Michael H. Alveolar Rhabdomyosarcoma in a Juvenile Labrador Retriever: Case Report and Literature Review. J Am Anim Hosp Assoc 2011; 47:443-6. [DOI: 10.5326/jaaha-ms-5693] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 7 mo old Labrador retriever presented for evaluation of facial swelling associated with a 5 cm oral mass extending caudally from the upper third premolar on the left side. Cytology revealed an atypical population of round cells of undetermined origin. A diagnosis of alveolar rhabdomyosarcoma (RMS) was reached via histopathology and confirmed with positive immunohistochemical staining for desmin. In humans, RMSs have a well-described round cell cytologic appearance. Few descriptions of veterinary cases of RMS exist. This report describes the cytologic appearance of alveolar RMS in a young dog and both summarizes and compares findings throughout the veterinary and human literature.
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Affiliation(s)
- Laura A. Snyder
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - Helen Michael
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
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Fassina A, Olivotto A, Cappellesso R, Vendraminelli R, Fassan M. Fine-needle cytology of cutaneous juvenile xanthogranuloma and langerhans cell histiocytosis. Cancer Cytopathol 2011; 119:134-40. [PMID: 21491610 DOI: 10.1002/cncy.20132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/12/2010] [Accepted: 11/15/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND In pediatric patients, a cutaneous nodule is usually diagnosed by performing an excisional biopsy, but fine-needle cytology (FNC) is a safer and noninvasive diagnostic method widely used to obtain diagnostic specimens with little stress to the patient. The authors compared the ability of FNC and biopsy to differentiate Langerhans cell histiocytosis (LCH) from juvenile xanthogranuloma (JXG). METHODS Correlating cytological results with histological findings, the authors reviewed 27 patients (15 males and 12 females; mean age, 37 months; range, 1 month to 14 years) admitted to the University of Padua Department of Pediatrics from 1998 to 2010. RESULTS Cytology smears were adequate in all 27 (100%) patients: 14 (52%) were classified as having JXG, 12 (44%) as having LCH, and 1 (4%) as having a doubtful finding. A biopsy was also performed in 20 of these patients, and in all but 1, the 2 methods were completely concordant. CONCLUSIONS FNC is safe and useful in the diagnostic workup of pediatric patients with cutaneous nodules and has no contraindications to its use as the initial diagnostic procedure.
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Affiliation(s)
- Ambrogio Fassina
- Department of Diagnostic Medical Sciences and Special Therapies, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy.
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Castelino-Prabhu S, Stoll LM, Li QK. Metastatic retinoblastoma presenting as a left shoulder soft tissue mass: FNA findings and review of the literature. Diagn Cytopathol 2009; 38:440-6. [PMID: 19937945 DOI: 10.1002/dc.21252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Retinoblastoma is a relatively rare malignant pediatric tumor accounting for approximately 3% of childhood cancers and 1% of all cancer deaths in children under 15 years of age. During the clinical course of the disease, a metastasis usually occurs within the first year of diagnosis and is seen in 2% of retinoblastoma patients. Metastases to the intracranial region are common and account for approximately 50% of the metastatic cases. Metastasis to the soft tissue is very rare. Herein, we report a case of metastatic retinoblastoma presenting as a left shoulder soft tissue mass in a 14-year-old female with a 14-year history of familial bilateral retinoblastoma status post radiation therapy. In our case, the FNA cytology shows some features of the small round blue cell tumor group with inconspicuous Flexner-Wintersteiner or Homer-Right rosette formation. The unusual clinical presentation and morphology give rise to a diagnostic dilemma, with the differential diagnosis centering on the small round blue cell tumors such as lymphoma, rhabdomyosarcoma, nephroblastoma (Wilms' tumor), Ewing's sarcoma/PNET, and desmoplastic small round cell tumor. It also prompts concern for the development of a second primary tumor. The purpose of our study is to discuss the FNA cytology of metastatic retinoblastoma, its differential diagnoses, and the utility of immunohistochemistry. An accurate diagnosis is imperative due to the differences in prognosis and treatment implications for the various diseases.
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Affiliation(s)
- Shobha Castelino-Prabhu
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Rapkiewicz A, Thuy Le B, Simsir A, Cangiarella J, Levine P. Spectrum of head and neck lesions diagnosed by fine-needle aspiration cytology in the pediatric population. Cancer 2007; 111:242-51. [PMID: 17554755 DOI: 10.1002/cncr.22769] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fine-needle aspiration cytology (FNAC) of the head and neck region is well accepted as a diagnostic procedure in the adult population. FNAC in the pediatric population is gaining acceptance as clinicians add this technique to the diagnostic armamentarium. An experience with FNAC of the head and neck region in the pediatric population is described from 2 large inner-city hospitals. Eighty-five cases were retrieved from patients age <18 years. In 52 cases, clinical or surgical follow-up was obtained and among these cases the specificity and sensitivity of FNA was 93% and 100%, respectively. The high specificity of FNAC allows the clinician to be confident of malignancy in a clinically suspicious lesion of the head and neck in a pediatric patient.
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Affiliation(s)
- Amy Rapkiewicz
- Department of Pathology, New York University, New York, New York 10016, USA.
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