Asteroid bodies and calcium oxalate crystals: two infrequent findings in fine-needle aspirates of parotid sarcoidosis

Clinico-cytomorphological Spectrum of Calcinosis Cutis

Introduction

The deposition of calcium in the skin is known as calcinosis cutis. It can affect any part of the body and can mimic soft tissue or bony lesions clinically.

Aim

To describe the clinical and cytomorphologic features of calcinosis cutis on fine needle aspiration cytology smears.

Materials and Methods

A total of 17 cases reported as calcinosis cutis on fine needle aspiration cytology were reviewed for the available clinical and cytological details.

Results

The cohort included both adult and pediatric patients. Clinically, the lesions appeared as painless swellings of variable sizes. The common sites affected were the scrotum, iliac region, scalp, pinna, neck, axilla, elbow, arm, thigh, and gluteal region. Aspirate was chalky white, paste-like in all the cases. The cytologic evaluation revealed amorphous crystalline deposits of calcium along with histiocytes, lymphocytes, and multinucleated giant cells.

Conclusions

Calcinosis cutis has a wide spectrum of clinical presentations. Fine needle aspiration cytology is a minimally invasive approach for diagnosing calcinosis cutis, thus eliminating the need for more extensive biopsy procedures.

Crystals and crystalloids in cytopathology: Incidence and importance

Many crystals and crystal-like structures may be encountered in cytopathology practice and can represent both beautiful novelties and diagnostic aids. The authors present an organ-specific review of the published literature on crystals combined with personal experiences. The purpose is not only to serve as a reference guide by highlighting the clinical and morphologic features of crystals, crystalloids, and crystal-like structures but also to review their significance and to offer reporting strategies in cases that bear management implications.

Bilaterally enlarged parotids and sicca symptoms as a presentation of sarcoidosis: Pivotal role of aspiration cytology in diagnosis

Sarcoidosis is a chronic multisystem inflammatory disease of unknown etiology characterized by widespread noncaseating granulomas in various organs. The diagnosis of sarcoidosis is based on cytological, clinicolaboratory, and radiological findings, and requires careful exclusion of other granulomatous diseases especially tuberculosis. Involvement of parotid glands is uncommon. Presentation of sarcoidosis with sicca symptoms that include dryness of eyes and mouth is an even rarer phenomenon. We present a case of multisystemic sarcoidosis presenting with dryness of eyes and mouth along with bilateral enlargement of parotid glands. Fine-needle aspiration cytology (FNAC) smears showed epithelioid cell granulomas and multinucleate giant cells. Stain for acid-fast bacilli was negative. Careful cytological examination revealed crystalline structures inside the giant cells, which prompted us to evaluate the patient for sarcoidosis. This case report highlights the cytological features that can be useful in clinching the diagnosis of sarcoidosis in conjunction with clinicoradiological and laboratory findings in a clinically unusual case.

Silicone lymphadenopathy: presentation of a further case containing asteroid bodies on fine-needle cytology sample

Silicone lymphadenopathy is a recognized complication of breast augmentation. It is thought to occur when silicone droplets migrate from breast implants to lymph nodes. We report the cytologic findings in axillary and inguinal lymph node aspirate smears from a 35-year-old Italian woman, who came to our observation 10 years after bilateral cosmetic breast augmentation. A fine-needle cytology of the axillary lymph node showed extensive granulomatous inflammation, numerous histiocytes, and multinucleated giant cells containing star-shaped structures known as "asteroid bodies." The inguinal lymph node aspirate simply showed an aspecific reactive hyperplasia. No evidence of malignancy was present in any of the smears as well as in the excised axillary lymph node.

Calcinosis cutis: diagnosis by fine needle aspiration cytology--a rare case report

Calcinosis cutis is characterized by deposition of calcium salts in the subcutaneous tissues in the body. In this study, we described a case of calcinosis cutis that was diagnosed by fine needle aspiration (FNA) in a 15-year-old male. The patient presented with multiple nodules over right forearm and right knee. FNA smears showed flakes of amorphous material indicating calcium along with few macrophages. The presence of amorphous calcium salts along with histiocytes in the appropriate clinical settings is diagnostic of calcinosis cutis.

Aspiration cytodiagnosis of the breast with abundant acellular calcific material indicative of soft tissue calcinosis (a study of 3 cases)

Calcific deposits in soft tissue are rare and may clinically resemble a tumour. It seems feasible, therefore, to investigate them by the non-invasive technique of fine needle aspiration cytology (FNAC). In this study three cases with extensive accumulation of acellular calcific material in the breast are described in which FNAC was indicative of soft tissue calcinosis. In all cases routine mammogram had shown a partially cystic opacity. All other investigations were normal and no significant family or medical history was present. Cytopreparations in all cases showed only abundant acellular calcium. The patients had no further treatment and on follow up were clinically well with no changes. The cases are interesting, since the cytohistological findings in the aspirate sample appeared to be strongly indicative of soft tissue calcinosis.

Fine-needle aspiration of spindle cell and mesenchymal lesions of the salivary glands

Fine-needle aspiration (FNA) biopsy can accurately diagnose epithelial lesions of the salivary gland. Its role in the evaluation of salivary gland lesions containing a significant spindle cell component is less clear. We describe the cytologic features of 25 spindle cell lesions of the salivary gland and discuss the differential diagnosis and potential diagnostic pitfalls. Twenty-five aspiration smears (3.0%) containing a significant spindle cell or mesenchymal component were identified out of 844 salivary gland FNAs performed over a 5-year period. These aspiration smears were from 25 patients. The smears were classified into three categories: 1) reactive or inflammatory conditions, including one granulation tissue and four granulomatous sialoadenitis; 2) benign neoplasms, including one schwannoma, one fibromatosis, four lipomas, and nine pleomorphic adenomas; 3) malignant neoplasms, including one recurrent malignant fibrous histiocytoma (MFH), two metastatic melanomas, and two metastatic osteosarcomas. There was one false-negative biopsy. The metastatic desmoplastic malignant melanoma was initially interpreted as a reactive lymph node with fibrosis. A specific diagnosis was rendered in 21 (84%) cases. The schwannoma was diagnosed cytologically as benign spindle cell lesion, not otherwise specified (NOS), fibromatosis as an atypical cellular proliferation, and MFH as poorly differentiated malignant neoplasm. Salivary gland lesions with a significant spindle cell component are rarely encountered on FNA and constitute a heterogeneous group. A specific diagnosis can be rendered in the majority of cases by correlating clinical and cytologic findings.

Fine-needle aspiration cytology of the breast in a case with abundant acellular calcific material indicative of soft-tissue calcinosis

Since calcific deposits in soft tissue may clinically resemble a tumor, it is feasible to investigate them by fine-needle aspiration (FNA) cytology. In this presentation we describe a case in the breast with extensive accumulation of acellular liquid calcific material which was sampled by the noninvasive technique of FNA, and which was indicative of nonfamilial soft-tissue calcinosis. A 48-yr-old, perimenopausal woman on a routine mammogram showed a well-defined, 1-cm partially cystic opacity in the left upper quadrant of the breast. All other investigations were normal, and no significant family or medical history was present. Under ultrasound guidance FNA was done, and about 1 ml of thick whitish fluid was obtained. Cytopreparations only showed abundant acellular calcium. The patient refused any further treatment and elected to be under the care of her family physician, according to whom she was clinically well with no changes in mammograms for the last 2 yr. The case is interesting, since the cytohistologic findings in aspirate sample appeared to be strongly indicative of soft-tissue calcinosis, which to our knowledge has not been previously reported.

Fine-needle aspiration cytology of soft-tissue calcinosis presenting as an enlarging mass in the chest wall

Calcinosis cutis is an uncommon condition, and calcific deposits in patients with end-stage renal disease are now somewhat rare, due to improvement in management. Since calcific deposits may clinically resemble a tumor, it is feasible to investigate them by fine-needle aspiration cytology (FNAC). A 52-yr-old male with a history of end-stage renal failure presented with a 2-cm mass in the left chest wall. Within 6 mo the mass enlarged to nearly four times its original size. In view of clinical suspicion of malignancy, FNAC was performed. Cytopreparations showed abundant calcium, indicative of soft-tissue calcinosis. The case is interesting, since the known history of end-stage renal failure enabled the FNAC diagnosis of soft-tissue calcinosis.

Asteroid bodies and other cytoplasmic inclusions in necrobiotic xanthogranuloma with paraproteinemia

BACKGROUND

Necrobiotic xanthogranuloma (NXG) with paraproteinemia is a distinctive palisading granuloma of the skin. Extracutaneous lesions are rarely present.

OBJECTIVE

The purpose of this study was to confirm the presence and significance of giant cell asteroid bodies and other cytoplasmic inclusions in NXG with paraproteinemia.

METHODS

Skin biopsy specimens from 24 patients with NXG with paraproteinemia were reviewed; autopsy and lung biopsy specimens from two patients were stained for iron, calcium, and polysaccharide.

RESULTS

Giant cell asteroid bodies were observed in skin biopsy specimens of 8 (33%) of the 24 patients. In addition, large acidophilic polygonal cytoplasmic inclusions were observed in myocardial tissue of one of the autopsy cases. Iron and calcium were not found.

CONCLUSION

Asteroid bodies and other inclusions can be present in the giant cells of NXG with paraproteinemia. They are as frequent as, or more frequent than, in other granulomatous diseases and should be considered in the diagnosis of NXG with paraproteinemia.