1
|
Calo L, Alboni T, Bruno C, Policardo F, Feraco A, Tralongo P, Vegni F, Mulè A, Brigato F, Rossi G, Bussu F, Pantanowitz L, Galli J, Rossi ED. Metastases to the parotid glands: An institutional experience. Cytopathology 2024; 35:488-496. [PMID: 38752464 DOI: 10.1111/cyt.13387] [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: 02/22/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Metastatic lesions to the salivary gland are rare and mostly affect the parotids. Metastases represent 8% of all malignant lesions of the parotid gland. Around 80% originate from squamous cell carcinomas (SCC) of the head and neck region. Fine needle aspiration (FNA) plays a crucial role in distinguishing primary salivary gland lesions from metastases. Herein we describe our series of metastases to the parotid glands. MATERIALS AND METHODS We analysed 630 parotid gland FNAs over a decade including conventional and liquid-based cytology specimens. Ancillary techniques such as immunocytochemistry (ICC) were conducted on cell blocks. RESULTS Eighty (12.4%) cases were malignant lesions, of which 53 (63.75%) were metastases including 24% melanoma, 22.6% SCC, 19% renal carcinomas, 7.5% breast carcinomas, 11.3% lung, 9% intestinal and 1.8% testicular, malignant solitary fibrous tumour and Merkel cell carcinoma. The 53 cases, classified according to the Milan system for salivary cytopathology, belonged to 5 Suspicious for malignancy (SFM) and 48 malignant (M) categories. Forty had a known history of primary malignancy (75.4%), while 13 were suspicious to be a metastatic localisation (24.5%), distributed as 5SFM (2SCC and 3Melanoma) and 8 M. A combination of clinical history, cytomorphology and ICC identified 100% of them. CONCLUSIONS Fine needle aspiration plays a central role in the diagnostic workup of patients with metastatic lesions to their parotid glands, thereby defining the correct management. Diagnostic accuracy may be enhanced by applying ICC. Although melanoma and SCC are the most common histological types, several other malignancies may also metastasize to the parotid glands and should be kept into consideration.
Collapse
Affiliation(s)
- Lea Calo
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Tiziana Alboni
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Carmine Bruno
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Policardo
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Angela Feraco
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Federica Vegni
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Antonio Mulè
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| | - Francesca Brigato
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Giorgia Rossi
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Francesco Bussu
- Division of Head and Neck, Policlinico di Sassari, Sassari, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacopo Galli
- Division of Head and Neck-Surgery, fondazione policlinico universitario agostino gemelli-IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology-Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy
| |
Collapse
|
2
|
Saoud C, Lam H, Gross JM, Ali SZ. Fine needle aspiration of bone lesions: A tertiary care centre experience. Cytopathology 2023; 34:562-572. [PMID: 37434498 DOI: 10.1111/cyt.13270] [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: 02/22/2023] [Revised: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Bone fine needle aspiration (FNA) presents several diagnostic challenges including limited sample material, reduced ability to assess the architecture, and lack of a standardised reporting system. The aim of our study is to present our experience regarding bone FNA. METHODS We performed a 6-year retrospective search of our archives to identify all FNA cases of bone lesions. Available data regarding patients' demographics, cytopathology, and surgical pathology were recorded. The FNA cases were then grouped into five categories (atypical, neoplasm-benign, neoplasm of unknown malignant potential, suspicious for malignancy, and malignant) and the risk of malignancy (ROM) was calculated. RESULTS A total of 341 FNA cases performed in 337 patients (M = 173, F = 164; mean age = 57.2 years) were identified. The iliac crest was the most commonly biopsied site (n = 134). The adequacy of bone FNA was 77.4%. The sensitivity and specificity regarding the nature of the lesion were 96.5% and 100%, respectively. The overall diagnostic accuracy of bone FNA was 77%. The accuracy of bone FNA for non-metastatic bone lesions including non-neoplastic lesions was 74%, while the diagnostic accuracy of bone FNA for a metastatic disease was 83.5%. The diagnostic accuracy for primary neoplastic lesions was 70%. The frequency (n,%) of cytomorphological categories were as follows: atypical (30, 8.8%); neoplasm-benign (6, 1.8%); neoplasm of unknown malignant potential (18, 5.3%); suspicious for malignancy (4, 1.2%); and malignant (145, 42.5%). The ROM in these categories was respectively as follows: 51.7%, 0%, 46.7%, 100%, and 99.1%. CONCLUSION FNA is a sensitive and specific technique for the diagnosis of bone lesions. In most instances, an accurate diagnosis can be achieved if adequate material, ancillary studies, and radiological correlation are available.
Collapse
Affiliation(s)
- Carla Saoud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hansen Lam
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John M Gross
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Gbadamosi WA, Knezevic-Maragh M, Talukder P, Smith W, Sanchez EZ. Pre-resection Embolization of a Focal Lumbar Chordoma. Cureus 2023; 15:e38406. [PMID: 37265900 PMCID: PMC10231904 DOI: 10.7759/cureus.38406] [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] [Accepted: 05/01/2023] [Indexed: 06/03/2023] Open
Abstract
Chordoma is a slow-growing local invasive tumor with high mortality and recurrence rates after surgical resection. It can affect the clivus and sacrum and rarely involve the lumbar vertebra. There is limited literature research describing lumbar embolization before surgical resection in lumbar chordoma. Thus, this case report describes an atypical patient with chronic lower back pain who presented to the hospital for worsening pain. Radiological images show an aggressive focal lesion at the second lumbar spine extending into the posterior element. The patient underwent lumbar artery embolization before surgical resection. The final pathology diagnosis confirmed a conventional chordoma. Therefore, patients with radiological imaging features of conventional chordoma may benefit from embolization prior to surgical resection to decrease intraoperative bleeding.
Collapse
Affiliation(s)
| | | | - Priotush Talukder
- College of Medicine, American University of Antigua, St. John's, ATG
| | - Weber Smith
- Pathology and Laboratory Medicine, Medical Center of Trinity, Trinity, USA
| | | |
Collapse
|
4
|
Chordoma: analysis of 47 fine-needle aspiration biopsy, cytologic imprint, and small biopsy specimens. J Am Soc Cytopathol 2023; 12:30-40. [PMID: 36270910 DOI: 10.1016/j.jasc.2022.09.005] [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: 07/01/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) and small tissue biopsy of chordoma have been reported in several small series, but no large series exists. We undertook an examination of 47 cases (with concurrent core needle biopsy in a subset) to analyze diagnostic accuracy, cytomorphology, and immunohistochemistry. MATERIALS AND METHODS Our cytopathology files were searched for examples of chordoma with histopathologic verification. FNA biopsy smears and core needle were performed using standard techniques. RESULTS Forty-seven cases of chordoma were retrieved from 44 patients [M:F; 1.8:1; age range 5-81 years; mean age 55 years]. Twenty-seven presented with primary, 10 with locally recurrent, and 7 with metastatic tumors. Two aspirates were from the appendicular skeleton, 2 from the trunk, 1 from neck lymph node, and 42 aspirates (89%) from axial and peri-axial skeleton and surrounding soft tissues. Four were cytologic touch imprints while the remainder were FNA biopsy specimens. Specific cytologic diagnoses were chordoma/consistent with chordoma (44 cases, 94%), suspicious for chordoma (2), and malignant neoplasm (1). Along with a single case of benign notochordal tumor misdiagnosed as chordoma, our diagnostic accuracy was 91%. Concurrent tissue biopsy was performed in 51% of cases. Immunohistochemical staining of tumor in 29 (62%) cases showed expression of brachyury in 23 of 24 (96%) instances. Cytopathology consisted of cellular smears populated by large cells possessing enormous amounts of vacuolated and non-vacuolated cytoplasm with an abundant background myxoid/chondromyxoid stroma. CONCLUSIONS FNA and small tissue biopsy specimens show a very high degree of diagnostic accuracy in recognition of chordoma.
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Thompson LDR, Bishop JA. Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Nasal Cavity, Paranasal Sinuses and Skull Base. Head Neck Pathol 2022; 16:1-18. [PMID: 35312976 PMCID: PMC9018924 DOI: 10.1007/s12105-021-01406-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/17/2021] [Indexed: 12/31/2022]
Abstract
The World Health Organization Classification of Head and Neck Tumours recently published the 5th edition. There are new entities, emerging entities, and significant updates to the taxonomy and characterization of tumor and tumor-like lesions, specifically in this article as it relates to nasal cavity, paranasal sinuses and skull base. Importantly, the number of diagnostic entries has been reduced by creating category-specific chapters for soft tissue, hematolymphoid, melanocytic, neuroectodermal, and metastatic tumors. Bone and salivary gland tumors are also not separately reported in the sinonasal tract, but included in the jaw and salivary gland sections, respectively. Repetition of characteristic entities in each anatomic site was also reduced, instead highlighting only the unique features in each anatomic site. Two new entities (SWI/SNF complex-deficient sinonasal carcinomas and HPV-related multiphenotypic sinonasal carcinoma) will be highlighted in this review, with a discussion of several emerging entities. There is a short description of updated information for all 24 diagnostic entities included in this edition to allow the reader a snapshot of current state of knowledge, but to encourage more investigation and further broaden understanding of these diverse and rare entities.
Collapse
Affiliation(s)
- Lester D. R. Thompson
- Head and Neck Pathology Consultations, 22543 Ventura Boulevard, Ste 220 PMB1034, Woodland Hills, CA 91364 USA
| | - Justin A. Bishop
- University of Texas Southwestern Medical Center, Clements University Hospital, UH04.250, 6201 Harry Hines Blvd., Dallas, TX 75390 USA
| |
Collapse
|
7
|
Wang L, Yee-Chang M, Sun W, Melamed J, Simsir A, Shi Y. Myoepithelial carcinoma of soft tissue is a diagnostic challenge on fine-needle aspiration: Case report and review of literature. Diagn Cytopathol 2022; 50:E203-E209. [PMID: 35224892 DOI: 10.1002/dc.24950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/08/2022]
Abstract
Myoepithelial carcinoma (MEC) of soft tissue, also known as malignant myoepithelial tumor, is an uncommon malignancy. Cytologic diagnosis of this entity is challenging due to its rarity and heterogeneous morphology. We report a case of MEC in a 22-year-old man, who presented with a 6.5 cm soft tissue mass on his right distal forearm that has been enlarging over the past 3 months. Ultrasound-guided fine-needle aspiration (FNA) revealed abundant isolated neoplastic cells ranging from spindled cells to epithelioid and plasmacytoid morphology in a myxoid background. These cells showed moderate cytologic atypia characterized by high-nuclear/cytoplasmic ratio, irregular nuclear contours, and prominent nucleoli. The cytoplasm varied from dense to vacuolated and occasionally rhabdoid with intracytoplasmic inclusions. Scattered bi- and multinucleated cells were identified. A diagnosis of high-grade malignancy was made with the differential diagnosis including rhabdomyosarcoma and melanoma. A subsequent core biopsy of the tumor showed immunoreactivity for pan-cytokeratins, calponin, p63, and smooth muscle actin. INI-1 was lost. SOX-10 and Melan-A were negative. Molecular studies showed loss of SMARCB1 (INI-1) and CDKN2A. Gene fusion studies did not detect any fusion. A diagnosis of soft tissue MEC was made which is a challenge on FNA due to several cytologic mimickers including rhabdomyosarcoma, epithelioid sarcoma, extrarenal rhabdoid tumor, extra-axial chordoma and melanoma. Recognition of the biphasic cell population in a myxoid background and a battery of immunohistochemical stains are crucial for accurate diagnosis.
Collapse
Affiliation(s)
- Lucy Wang
- Department of Pathology and Laboratory Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Melissa Yee-Chang
- Department of Pathology and Laboratory Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Wei Sun
- Department of Pathology and Laboratory Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Jonathan Melamed
- Department of Pathology and Laboratory Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Aylin Simsir
- Department of Pathology and Laboratory Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Yan Shi
- Department of Pathology and Laboratory Medicine, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
8
|
Pennington Z, Ehresman J, Pittman PD, Ahmed AK, Lubelski D, McCarthy EF, Goodwin CR, Sciubba DM. Chondrosarcoma of the spine: a narrative review. Spine J 2021; 21:2078-2096. [PMID: 33971325 DOI: 10.1016/j.spinee.2021.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/19/2021] [Accepted: 04/28/2021] [Indexed: 02/03/2023]
Abstract
Chondrosarcoma is an uncommon primary bone tumor with an estimated incidence of 0.5 per 100,000 patient-years. Primary chondrosarcoma of the mobile spine and sacrum cumulatively account for less than 20% of all cases, most .commonly causing patients to present with focal pain with or without radiculopathy, or myelopathy secondary to neural element compression. Because of the rarity, patients benefit from multidisciplinary care at academic tertiary-care centers. Current standard-of-care consists of en bloc surgical resection with negative margins; for high grade lesions adjuvant focused radiation with ≥60 gray equivalents is taking an increased role in improving local control. Prognosis is dictated by lesion grade at the time of resection. Several groups have put forth survival calculators and epidemiological evidence suggests prognosis is quite good for lesions receiving R0 resection. Future efforts will be focused on identifying potential chemotherapeutic adjuvants and refining radiation treatments as a means of improving local control.
Collapse
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, MN USA 55905; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287.
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ USA 85013.
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC USA 27710
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC USA 27710
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY USA 11030.
| |
Collapse
|
9
|
Pennington Z, Ehresman J, McCarthy EF, Ahmed AK, Pittman PD, Lubelski D, Goodwin CR, Sciubba DM. Chordoma of the sacrum and mobile spine: a narrative review. Spine J 2021; 21:500-517. [PMID: 33589095 DOI: 10.1016/j.spinee.2020.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
Chordoma is a notochord-derived primary tumor of the skull base and vertebral column known to affect 0.08 to 0.5 per 100,000 persons worldwide. Patients commonly present with mechanical, midline pain with or without radicular features secondary to nerve root compression. Management of these lesions has classically revolved around oncologic resection, defined by en bloc resection of the lesion with negative margins as this was found to significantly improve both local control and overall survival. With advancement in radiation modalities, namely the increased availability of focused photon therapy and proton beam radiation, high-dose (>50 Gy) neoadjuvant or adjuvant radiotherapy is also becoming a standard of care. At present chemotherapy does not appear to have a role, but ongoing investigations into the ontogeny and molecular pathophysiology of chordoma promise to identify therapeutic targets that may further alter this paradigm. In this narrative review we describe the epidemiology, histopathology, diagnosis, and treatment of chordoma.
Collapse
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA.
| |
Collapse
|
10
|
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.
Collapse
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
| | | |
Collapse
|
11
|
Pagliuca F, Ronchi A, Cozzolino I, Montella M, Zito Marino F, Franco R. Mesenchymal neoplasms: Is it time for cytology? New perspectives for the pre-operative diagnosis of soft tissue tumors in the molecular era. Pathol Res Pract 2020; 216:152923. [PMID: 32303388 DOI: 10.1016/j.prp.2020.152923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/08/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022]
Abstract
Soft tissue tumors comprise a great variety of common and rare entities with overlapping features. Their diagnosis is based on the evaluation of several histological parameters which are difficult to assess on small incisional biopsies. Useful diagnostic markers in the field of soft tissue tumors include: 1) molecular biomarkers detecting pathogenetically relevant, distinctive alterations; 2) immunohistochemical surrogate biomarkers of pathogenetically relevant, distinctive molecular alterations; 3) highly specific immunohistochemical biomarkers indicating tumor differentiation. Their introduction in clinical practice has revolutionized the pre-operative diagnosis of soft tissue tumors. Cytology has long been considered inadequate as a first-line approach in this setting. However, since the implementation of new immunohistochemical and molecular tests with high diagnostic specificity, fine needle aspiration cytology (FNAC) is starting to gain acceptance for the pre-operative assessment of soft tissue tumors. FNAC represents a versatile, poorly expensive and well-tolerated diagnostic strategy with relevant advantages over histological biopsies. Moreover, evidences suggest that, in expert hands, FNAC can also aim at a definite diagnosis, especially if a cell block is prepared, allowing the application of multiple ancillary techniques.
Collapse
Affiliation(s)
- Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| |
Collapse
|
12
|
Rekhi B, Karmarkar S. Clinicocytopathological spectrum, including uncommon forms, of nine cases of chordomas with immunohistochemical results, including brachyury immunostaining: A single institutional experience. Cytopathology 2018; 30:229-235. [PMID: 30218622 DOI: 10.1111/cyt.12631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present clinical and cytopathological features of nine cases of chordomas, diagnosed over 9 years and confirmed by brachyury (T) immunostaining. METHODS Conventional cytological smears, stained with Papanicolaou and May-Grünwald Giemsa, along with corresponding histopathological (n = 8) and immunostained sections (n = 8) were reviewed. Immunohistochemical staining was performed on tissue sections by polymer detection technique. RESULTS Nine tumours occurred in seven males and two females, with age ranging from 36 to 72 years (average = 58.7), in the sacrum (seven) and spine (two). On fine needle aspiration cytology, five cases were either diagnosed with or diagnosed with a suggestion of a chordoma, while three cases were diagnosed with chordoma as a differential diagnosis. On review, smears were moderately cellular, comprising myxoid stroma (9/9), epithelioid cells (9/9), physaliphorous cells (8/9), including binucleation (7/9), prominent nucleolisation (2/9), pleomorphic cells (2/9) and intranuclear inclusions (3/9). Immunohistochemically, tumour cells expressed cytokeratin (4/4), pan cytokeratin (4/4), epithelial membrane antigen (8/8), S100 protein (6/8) and brachyury (8/8). Five patients underwent surgical excision, including two who underwent adjuvant radiotherapy (RT) and four patients who underwent RT. During follow-up (n = 8), a single patient developed recurrence and another presented with metastatic lesions. Finally, five patients were alive with disease (7-53 months); a single patient was free of disease (4 months), and two patients died of disease; the latter cases displayed pleomorphic cells and intranuclear inclusions. CONCLUSIONS Chordomas can be primarily diagnosed by fine needle aspiration cytology in a typical clinicoradiological setting with a combination of key cytomorphological features. Pleomorphic cells and intranuclear inclusions are associated with a relatively aggressive subtype. An exact diagnosis has treatment implications and requires confirmation by brachyury immunostaining.
Collapse
Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India
| | - Srushti Karmarkar
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, India
| |
Collapse
|
13
|
Updates in Primary Bone Tumors: Current Challenges and New Opportunities in Cytopathology. Surg Pathol Clin 2018; 11:657-668. [PMID: 30190146 DOI: 10.1016/j.path.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The review summarizes the current diagnostic challenges in fine-needle aspiration of primary bone tumors, with focus on the application of new molecular and immunohistochemical techniques in the diagnosis of giant cell-rich neoplasms, chondrosarcomas, and notochordal tumors.
Collapse
|
14
|
Goodarzi A, Toussi A, Lechpammer M, Lee D, Shahlaie K. Intradural Chordoma of Cerebellopontine Angle: Case Report and Review. World Neurosurg 2017; 107:1052.e11-1052.e16. [PMID: 28866065 DOI: 10.1016/j.wneu.2017.08.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chordomas are rare, notochord-derived neoplasms. Of these tumors, intradural chordomas are exceedingly rare. Most occur within the prepontine, parasellar, or other midline intradural locations. An intradural chordoma arising from the cerebellopontine angle has not been described previously. CASE REPORT We describe the first case of an intradural chordoma originating from the left cerebellopontine angle resected over the course of 2 operations. CONCLUSIONS Intradural chordomas are rare and can arise anywhere in the posterior fossa. Lack of bony involvement on computed tomography and magnetic resonance imaging are indicative of this pathology when there is also a lack of markers indicating the presence of more common cerebellopontine angle tumors. Treatment goals should include gross total resection and possible radiation therapy.
Collapse
Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Atrin Toussi
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Mirna Lechpammer
- Department of Pathology, University of California, Davis, California, USA
| | - Darrin Lee
- Department of Neurological Surgery, University of California, Davis, California, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis, California, USA.
| |
Collapse
|
15
|
Multicentric Chordoma : An Uncommon and Incompletely Understood Presentation. Clin Neuroradiol 2017; 28:283-288. [PMID: 28766007 DOI: 10.1007/s00062-017-0610-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
|
16
|
Flowers A, Turbat-Herrera E. EM proves invaluable in the confirmation of chordoma in the sacral mass of a middle-aged man. Ultrastruct Pathol 2017; 41:258-263. [PMID: 28524812 DOI: 10.1080/01913123.2017.1311392] [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: 10/19/2022]
Abstract
A case of a 47-year-old male with a sacral spine mass was investigated by histology, immunohistochemistry (IHC), and electron microscopy (EM). The light microscopy of the first core biopsy revealed scant cellularity with spindle and round cells with eosinophilic cytoplasm within a fibromyxoid background. Immunostaining with pancytokeratin, cytokeratin 19, and S100 was nonspecific. Another biopsy was attempted to obtain a more definitive diagnosis. Light microscopy of the second core had scant cellular material. However, the tissue was specifically requested for ultrastructural evaluation and revealed features diagnostic of chordoma. After definitive diagnosis, radical resection of the mass was performed. This case illustrates how EM was instrumental in the definitive diagnosis before radical resection in a case that was not clear by hematoxylin and eosin (H&E) and IHC alone.
Collapse
Affiliation(s)
- A Flowers
- a Department of Pathology and Translational Pathobiology , Louisiana State University Health Sciences Center , Shreveport , LA , USA
| | - E Turbat-Herrera
- a Department of Pathology and Translational Pathobiology , Louisiana State University Health Sciences Center , Shreveport , LA , USA.,b Department of Cell Biology and Anatomy , Louisiana State University Health Sciences Center , Shreveport , LA , USA.,c Feist-Weiller Cancer Center , Shreveport , LA , USA
| |
Collapse
|
17
|
Frequency and Risk Factors for Additional Lesions in the Axial Spine in Subjects With Chordoma: Indications for Screening. Spine (Phila Pa 1976) 2017; 42:E37-E40. [PMID: 27254658 DOI: 10.1097/brs.0000000000001723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE We aim to evaluate the frequency and clinical significance of additional lesions in the axial spine in subjects with chordoma and to assess the need for screening. SUMMARY OF BACKGROUND DATA Chordomas are rare tumors that may be multicentric or metastasize and affect several bones in the axial spine. The incidence of multiple lesions in the axial spine is unknown. Understanding the incidence rate of multiple lesions in the spine in subjects with chordomas will help guide utilization of total spine screening imaging. METHODS We performed a retrospective review of medical records of 42 subjects with histologically confirmed chordomas who had complete imaging of the axial spine. Lesions with imaging characteristics suggestive of chordomas/notochordal remnants were identified. Data on age at diagnosis, sex, size (in maximal dimension), type of chordoma (conventional, chondroid, or dedifferentiated), and whether pulmonary metastases were present were recorded. Binomial two-sample tests of proportions were used to compare proportions. Logistic regression was used to assess predictors of additional lesions. RESULTS Forty-two subjects (57.1% male) were identified. The proportion of subjects with additional lesions in the axial spine was 16.7% (7/42). Age, sex, size, and subtype of chordoma were not significant predictors of having additional lesions (P > 0.05 for each variable). However, having pulmonary metastases was a significant predictor of having additional lesions (P < 0.05). CONCLUSION Approximately 17% of subjects with chordomas had additional lesions in the axial spine. It is unclear whether these represent metastases, synchronous primary chordomas or notochordal remnant tissue. Screening imaging of the axial spine may reveal additional lesions in particular in subjects with pulmonary metastases. LEVEL OF EVIDENCE 3.
Collapse
|
18
|
Abstract
Chordomas are rare primary bone tumors arising from embryonic remnants of the notochord. They are slow-growing, locally aggressive, and destructive and typically involve the axial skeleton. Genetic studies have identified several mutations implicated in the pathogenesis of these tumors. Treatment poses a challenge given their insidious progression, degree of local invasion at presentation, and high recurrence rate. They tend to respond poorly to conventional chemotherapy and radiation. This makes radical resection the mainstay of their treatment. Recent advances in targeted chemotherapy and focused particle beam radiation, however, have improved the management and prognosis of these tumors.
Collapse
Affiliation(s)
- Carl Youssef
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Salah G Aoun
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Jessica R Moreno
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| | - Carlos A Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, USA
| |
Collapse
|
19
|
Wang H, Hoda RS, Faquin W, Rossi ED, Hotchandani N, Sun T, Pusztaszeri M, Bizzarro T, Bongiovanni M, Patel V, Jhala N, Fadda G, Gong Y. FNA biopsy of secondary nonlymphomatous malignancies in salivary glands: A multi-institutional study of 184 cases. Cancer Cytopathol 2016; 125:91-103. [DOI: 10.1002/cncy.21798] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022]
Affiliation(s)
- He Wang
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Raza S. Hoda
- Department of Pathology; Massachusetts General Hospital, Harvard University; Boston Massachusetts
| | - William Faquin
- Department of Pathology; Massachusetts General Hospital, Harvard University; Boston Massachusetts
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | - Nihar Hotchandani
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Tianlin Sun
- Department of Pathology; Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Marc Pusztaszeri
- Department of Pathology; Geneva University Hospital; Geneva Switzerland
| | - Tommaso Bizzarro
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | | | - Viren Patel
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Nirag Jhala
- Department of Pathology and Laboratory Medicine; Temple University Hospital; Philadelphia Pennsylvania
| | - Guido Fadda
- Department of Anatomic Pathology and Histology; the Catholic University of Rome; Rome Italy
| | - Yun Gong
- Department of Pathology; Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center; Houston Texas
| |
Collapse
|
20
|
Differences in sex distribution, anatomic location and MR imaging appearance of pediatric compared to adult chordomas. BMC Med Imaging 2016; 16:53. [PMID: 27609115 PMCID: PMC5016865 DOI: 10.1186/s12880-016-0149-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Chordomas are rare malignancies that primarily affect adults, but also rarely affect pediatric patients. We compared the imaging appearance, demographic and anatomic distributions of adult and pediatric chordomas in a large cohort. Methods We performed a retrospective review of medical records of 220 subjects with histologically confirmed chordomas of the axial skeleton and pre-treatment magnetic resonance imaging studies. Age, sex, type of chordoma (conventional, chondroid or dedifferentiated), the anatomic location of the chordoma, as well as whether the lesion was primarily extra-osseous were recorded. Pediatric subjects were less than 21 years at the time of diagnosis. Binomial two-sample tests of proportions and Fisher’s exact tests were used to compare proportions between the pediatric and adult subjects. Results Fifty six pediatric subjects (58.9 % female) and 164 adult subjects (42.1 % female) were identified. The proportion of female subjects with chordomas was significantly higher in the pediatric cohort compared to the adult cohort (P = 0.04). Most chordomas occur in Caucasians, however African-Americans were more represented in the pediatric cohort than in the adult cohort (P = 0.01). 69.6 % (39/56) of the pediatric chordomas involved the clivus/skull base and cervical spine compared to 29.3 % (48/164) of the adult chordomas (P = 1.99 × 10−7). Only 1.8 % (1/56) of the pediatric chordomas was in the sacrococcygeal region compared to 36.0 % (59/164) of the adult chordomas (P = 2.55 × 10−8). In cases where pre-treatment imaging was available, 93.8 % (16/17) of pediatric chordomas were predominantly extra-osseous compared to 76.7 % (46/60) of adult chordomas (P = 0.17). Conclusions Pediatric chordomas more often affect females and occur most frequently at the craniocervical junction with decrease in incidence distally in the spine, whereas adult chordomas most frequently involve the craniocervical and sacrococcygeal regions.
Collapse
|
21
|
Anderson ME, Wu JS, Vargas SO. CORR(®) Tumor Board: Sacral Insufficiency Fractures are Common After High-dose Radiation for Sacral Chordomas Treated With or Without Surgery. Clin Orthop Relat Res 2016; 474:630-2. [PMID: 26642785 PMCID: PMC4746151 DOI: 10.1007/s11999-015-4651-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Megan E. Anderson
- grid.239395.70000000090118547Orthopaedic Oncology Surgeon, Beth Israel Deaconess Medical Center and Boston Children’s Hospital, 330 Brookline Ave., Boston, MA 02215 USA
| | - Jim S. Wu
- grid.239395.70000000090118547Musculoskeletal Radiologist, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Sara O. Vargas
- grid.2515.30000000403788438Staff Pathologist, Boston Children’s Hospital, Boston, MA USA
| |
Collapse
|
22
|
Taylor KR, Garner MM, Russell K, Epperson ED, Grodi HA, Roff SR, Dumonceaux GA, Struthers JD, Dark MJ, Abbott JR. Chordomas at High Prevalence in the Captive Population of the Endangered Perdido Key Beach Mouse (Peromyscus polionotus trissyllepsis). Vet Pathol 2015; 53:163-9. [PMID: 25791038 DOI: 10.1177/0300985815575051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The Perdido Key beach mouse (Peromyscus polionotus trissyllepsis) is a critically endangered subspecies of the oldfield mouse. The captive population, currently maintained by 3 Florida zoos, is entirely derived from just 3 wild-caught ancestor mice. Necropsy and histopathology revealed chordoma of the vertebral column in 38 of 88 (43%) mice. The tumors were locally expansile and invasive masses of large physaliferous (vacuolated) cells with small, round, hyperchromatic nuclei, similar to the "classic" form of chordomas described in humans. Primary tumors rarely contained small amounts of bone and cartilaginous matrix, characteristic of the "chondroid" form. Neoplastic cells contained abundant granules positive by the periodic acid-Schiff reaction. Brachyury and cytokeratin AE1/AE3 were detected in neoplastic cells by immunohistochemistry, but uncoupling protein 1 was not identified. Primary tumors occurred along the entire vertebral column--cervical, 5 of 38 (13%); thoracic, 16 (42%); lumbar, 13 (34%); and sacral, 10 (26%)--and 10 (26%) mice had multiple primary masses. Metastases to the lungs were noted in 13 of the 38 (34%) mice. Mice diagnosed with chordomas postmortem ranged from 424 to 2170 days old, with a mean of 1399 days. The prevalence of chordoma was not significantly different between males (n = 23 of 50; 46%) and females (n = 15 of 38; 39%).
Collapse
Affiliation(s)
- K R Taylor
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | | | - K Russell
- Santa Fe College Teaching Zoo, Gainesville, FL, USA
| | - E D Epperson
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - H A Grodi
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - S R Roff
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - G A Dumonceaux
- Palm Beach Zoo and Conservation Society, West Palm Beach, FL, USA
| | - J D Struthers
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - M J Dark
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - J R Abbott
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|