Fine needle aspiration cytology and cell block in the diagnosis of seminoma testis

The Utility of Fine Needle Aspiration (FNA) Biopsy in the Diagnosis of Mediastinal Lesions

Fine needle aspiration is a minimally invasive, low-morbidity, and cost-efficient technique for the sampling of mediastinal lesions. Additionally, ancillary testing on FNA samples can be used for the refinement of diagnoses and for treatment-related purposes (flow cytometry, cytogenetics, immunohistochemistry, and molecular diagnostics). Mediastinal lesions, however, can show a variety of lineages and morphologic features, giving rise to diagnostic dilemmas. As a result, the differential diagnosis can vary widely and becomes especially challenging due to the smaller sample size on FNA and the variability in component sampling. For appropriate patient management and to determine the correct treatment strategies, accurate pathologic diagnoses are paramount. In this review, we present the cytomorphologic features together with the immunophenotypic findings of mediastinal lesions, with emphasis on the diagnostic challenges and pitfalls in FNA cytology samples, including smears and cell block sections.

Current status of percutaneous testicular biopsy for focal lesions

OBJECTIVE

The purpose of this review is to evaluate the current role of percutaneous testicular biopsy in the diagnosis of focal testicular lesions.

CONCLUSION

Percutaneous testicular biopsy can be either fine needle aspiration biopsy or trucut core needle biopsy. It is a well-tolerated and effective procedure useful in small testicular lesions, multifocal lesions, hematological malignancies, and focal lesions in single testis.

Ultrasonography Guided Fine Needle Aspiration Cytology with Preparation of Cell Blocks in the Diagnosis of Intra- Abdominal Masses

BACKGROUND

Ultrasonography guided Fine Needle Aspiration Cytology (FNAC) is currently the most favoured and increasingly used pre-operative diagnostic procedure in various deep seated neoplastic and non-neoplastic mass lesions. Cell blocks prepared from residual fine needle aspiration (FNA) material can aid in better morphologic assessment and contribute to establish a more definitive cytopathologic diagnosis.

AIM

To assess the value of ultrasonography guided FNAC in the diagnosis of intra-abdominal (non-pelvic) masses.

OBJECTIVES

To determine the reliability of ultrasonography guided FNAC in distinguishing neoplastic from non-neoplastic intra-abdominal mass lesions. To assess the usefulness of cell block as a complimentary diagnostic material in the morphologic evaluation of the lesions.

MATERIALS AND METHODS

Aspirate material was collected from 62 patients with clinically and/or radiologically detected abdominal mass under ultrasonographic (USG) guidance. Pelvic masses were excluded from the study. In every case an attempt was made to prepare cell block (CB) from any residual material after preparation of routine smears. The final cytomorphologic diagnosis was correlated with clinical and radiologic findings, histopathologic diagnosis, follow up and response to therapy information.

RESULTS

The diagnostic yield of USG guided FNAC was 96.77%. The cases included 42 malignant (67.74%), two (3.23%) benign, and 16 (25.8%) non-neoplastic lesions. Two (3.23%) smears were unsatisfactory for evaluation. In 45 out of 62 cases (72.58%) CB preparations were available. There was a good agreement between smear diagnosis and that observed on CB section. Additionally CB yielded better diagnostic material in 15.55% of cases and aided in establishing a more precise final cytopathologic diagnosis. Confirmation of diagnosis in the form of biopsy and/or surgically resected specimen and follow up was available in 56 cases. The overall diagnostic accuracy of USG guided FNAC was 96.43% with a sensitivity, specificity, positive predictive value and negative predictive value of 95.35%, 100%, 100% and 86.66% respectively.

CONCLUSION

USG guided FNA procedure provides a good diagnostic yield for intra-abdominal masses. Also it has high sensitivity and specificity in differentiating benign from malignant lesions. Cell block preparations facilitate better diagnosis of lesions when reviewed along with cytological smears.

Primary testicular diffuse large B-cell lymphoma: A case report focusing on touch imprint cytology and a non-germinal center B-cell-like phenotype

Primary diffuse large B-cell lymphoma (DLBCL) of the testis is a rare subtype of testicular tumor. While the histomorphology of testicular DLBCL is well described, a paucity of information in the literature exists with regard to the cytological diagnosis of this subtype of tumor. Touch imprint specimens were obtained from a testicular DLBCL occurring in a 64-year-old man. The cytological features of imprints were compared with the results obtained from histological and immunohistochemical examinations. Smears obtained from the touch imprints exhibited a high cellular yield consisting of discretely arranged monomorphic large cells with irregular nuclear membranes, scant cytoplasm and conspicuous nucleoli. Histologically, the tumor consisted of discohesive neoplastic lymphocytes that infiltrated diffusely and produced a wide separation of intact seminiferous tubules. Diffuse, intense immunostaining for CD45, CD20, MUM1 and Ki-67 led to the diagnosis of primary DLBCL of the testis with a non-germinal center B-cell-like phenotype. Careful observation of the touch imprint specimens of testicular DLBCL revealed a high cellularity with a predominant single-cell pattern of monomorphic cells demonstrating irregular nuclear membranes and conspicuous nucleoli. In addition, DLBCL is capable of developing in the testis and forming a predominantly discohesive cell population, suggesting the presence of a lymphoid malignancy. Thus, it may be possible to detect morphological features that are characteristic of DLBCL using imprint cytology. To the best of our knowledge, this is the first study reporting the diagnosis of testicular DLBCL using touch imprint cytology.