Fine Needle Aspiration Biopsies of the Head and Neck: The Surgical Pathologist's Perspective

Effectiveness of fine-needle aspiration cytology in the diagnosis of lateral cervical nonthyroid tumors

Given that the clinical and radiological examinations of lateral cervical masses are not always sufficient for deciding on appropriate management, the cytological examination of the material obtained by fine-needle aspiration might be an efficient tool in the preoperative investigation of these lesions.In this prospective cross-sectional study we evaluated the efficacy and diagnostic accuracy of fine-needle aspiration cytology in the assessment of lateral cervical nonthyroid tumors, by comparing its results with those of histopathology.A total of 58 patients with lateral cervical masses were included. Preoperative cytological results were compared with the histopathologic examination of surgical specimens.Both cytology and histology indicated that malignant tumors outnumbered benign lesions (62% vs 38%), with 88.9% of malignancies presenting in patients aged >50 years, but cytology was less effective at differentiating between benign and nontumor lesions. Cytology had 76.5% specificity and 78.1% sensitivity for identifying malignant lateral cervical lesions, and there was a concordance between the two diagnostic tests (McNemar test, P = 0.17, κ = 0.50, P <0.001).Fine-needle aspiration cytology is a simple, quick, and effective procedure that can aid in the preoperative evaluation of lateral cervical masses by differentiating benign tumors and inflammatory processes from malignancies and thus help in determining a subsequent therapeutic strategy.

Fine-needle aspiration cytology of metastatic nasopharyngeal carcinoma

Cytological features of nasopharyngeal carcinoma (NPC) were reviewed in an attempt to select cytological criteria that permit a specific recognition of metastases. For this purpose, 54 fine-needle aspiration (FNA) procedures from 43 patients with NPC were analyzed. Thirty-two (59.3%) procedures were performed before the histological diagnosis. In 25 (46.3%) procedures, smears showed many neoplastic single cells, clusters, and abundant lymphoid cells (mixed pattern). A dissociated (single cell) pattern consisting of individual neoplastic and lymphoid cells was seen in 18 (33.3%) cases. Finally, 11 (20.4%) cases showed cohesive epithelial clusters (cohesive pattern) without relevant cellular dissociation or lymphoid cells. Squamous-cell differentiation was seen in three of these cases. Most single neoplastic cells presented as large, pleomorphic naked nuclei. Other interesting findings were granulomas (n = 3), prominent eosinophilic infiltrates (n = 4), and suppurative changes (n = 5). In most smears with mixed and dissociated patterns, a nasopharyngeal origin could be suggested. On the contrary, those smears with a cohesive pattern were indistinguishable from other head and neck carcinomas. The presence (on cervical lymph nodes) of a dissociated or mixed (single cells and groups) architectural pattern of large, anaplastic cells and naked nuclei accompanied by an abundant lymphoid component is highly suggestive of undifferentiated NPC. Cytology offers a rapid diagnosis, establishes the necessity of a complete cavum examination, and helps in avoiding unnecessary and harmful biopsies.

Simultaneous medullary carcinoma of the thyroid gland and Hodgkin's lymphoma in bilateral lymph nodes of the neck: a potential pitfall in fine-needle aspiration cytology

The clinicopathological features and the cytological findings of Hodgkin's lymphoma (HL) and medullary carcinoma (MC) of the thyroid gland are described appearing simultaneously in different organs of the cervical region of the same patient. Although the cytological features of both entities are well known, the rare clinical presentation and the epithelium-like Hodgkin and Reed-Sternberg (HRS) cells of the syncytial variant of HL led to an erroneous cytological diagnosis of metastatic carcinoma of the upper aerodigestive tract.

Fine-needle aspiration cytology of metastatic nasopharyngeal carcinoma in cervical lymph nodes: comparison with metastatic squamous-cell carcinoma, and Hodgkin's and non-Hodgkin's lymphoma

Our objective was to study the cytomorphological features of metastatic nasopharyngeal carcinoma (NPC) as compared to squamous-cell carcinoma (SCC) of nonnasopharyngeal origin, Hodgkin's lymphoma (HL), and non-Hodgkin's (NHL) lymphoma in the neck lymph nodes. The aim of this study was to find simple cytological criteria using routine stains that can help in differentiating between these entities. All fine-needle aspiration (FNA) smears of metastatic NPC, SCC, HL, and NHL from neck nodes available in our files were included in this study. Nodal disease was the first clinical manifestation in all cases of NPC, and all the lesions were of the nonkeratinizing type. The cytomorphological features of metastatic NPC, SCC, HL, and NHL have been described. Metastatic NPC and HL had a similar reactive lymphoid background, with eosinophils, plasma cells, and sometimes epithelioid-cell granulomas. The bizarre cells of NPC showed some resemblance to Reed-Sternberg cells of HL. However, the latter can be distinguished from the former on the basis of bulky, pale gray, vacuolated cytoplasm and vesicular nuclei with sharply demarcated prominent macronucleoli. In NPC, the neoplastic cells form distinct aggregates contrasting with the normal lymphoid cells in the background, which was different from the monotonous dispersed population of cells in NHL. Moreover, bizarre cells, prominent nucleoli, and the presence of plasma cells, eosinophils, and granulomas were not common features of NHL. The smears of metastatic SCC revealed keratinized malignant cells in all cases, while eosinophils and plasma cells were absent in the background. Plasma cells were seen intimately related to tumor cells in all cases of NPC. In conclusion, metastatic NPC can be differentiated from metastatic SCC of nonnasopharyngeal origin, HL, and NHL on the basis of simple nuclear and cytoplasmic features of malignant cells and their background. The presence of plasma cells intermingling with tumor-cell clusters is a good indicator of nasopharyngeal origin. On the other hand, a nasopharyngeal origin is unlikely in the presence of keratinized malignant cells.