Macrofollicular variant of papillary thyroid carcinoma diagnosed by fine needle aspiration biopsy: a case report

BACKGROUND

Macrofollicular variant of papillary thyroid carcinoma (PTC) is an uncommon, recently described thyroid tumor. By frozen section it can be confused easily with goiter or macrofollicular adenoma.

CASE

A 41-year-old female presented with a huge mass in the right thyroid lobe, cold on scintigraphy. By fine needle aspiration fluid was obtained. Smears of the sediment of the fluid showed epithelial cells with morphologic features diagnostic of PTC. Frozen section diagnosis was benign.

CONCLUSION

This is the first reported case of macrofollicular variant of PTC diagnosed preoperatively by cytology. In our case the cytology was similar to that of cystic PTC.

Atypical lipoma as a potential pitfall in the cytodiagnosis of subcutaneous tumors. A report of two cases

BACKGROUND

If well-differentiated liposarcomas of lipomalike type occur in the subcutis, they behave as benign neoplasms. For these tumors the term atypical lipoma was introduced in 1975. Fine needle aspiration (FNA) findings in these tumors may raise a false impression of malignancy.

CASES

Females aged 34 and 48 years presented with well-defined subcutaneous nodules in the left supraclavicular region and on top of the head, respectively. FNA showed fragments of mature fat tissue and numerous dispersed, large, hyperchromatic, often bizarre nuclei. Lipoma with atypical cells was diagnosed cytologically in one case and atypical lipoma in the other. Histologically both cases were evaluated as atypical lipoma.

CONCLUSION

A correct cytologic diagnosis of atypical lipoma can be established if cytomorphologic features are coupled with clinical data.

Edematous nasal polyp with atypical stromal cells misdiagnosed cytologically as rhabdomyosarcoma. A case report

Cytology, histology and immunohistology of an edematous nasal polyp with atypical stromal cells are described. The atypical cells were evaluated as rhabdomyosarcoma cells in touch smears.

Occult papillary microcarcinoma of the thyroid: a potential pitfall of fine needle aspiration cytology? Is it possible to avoid it?

Images

Papillary carcinoma of the thyroid with numerous spindle-shaped tumor cells in fine needle aspiration smears. A case report

A papillary carcinoma of the thyroid characterized by numerous spindle-shaped tumor cells in fine needle aspiration (FNA) smears is reported. The oval nuclei of the spindle cells, arranged in monolayered sheets, occasionally showed "rhythmic," palisaded patterns. Comparative study of cytology and histology of this tumor revealed that the spindle cells observed in FNA smears originated in the epithelium covering the edematous neoplastic papillae.

Fine needle aspiration cytology of rare malignant tumors of the breast

This report describes the fine needle aspiration (FNA) cytologic findings in 17 rare malignant breast tumors. The series consisted of invasive cribriform carcinoma, papillary carcinoma, apocrine carcinoma, carcinoma with pseudosarcomatous metaplasia, carcinosarcoma, fibrosarcoma, malignant phyllodes tumors, primary malignant lymphomas, plasmocytoma, metastatic melanoma and metastatic renal clear cell carcinoma. Besides cytomorphology, the results of immunostaining in eight cases are presented, as is a review of the literature. It is important for rare primary malignancies, as well as for metastatic tumors, to be diagnosed, or at least have the diagnosis suggested, preoperatively by FNA and immunocytochemistry, permitting better therapy planning.

Endoscopic brushing cytology of primary gastric choriocarcinoma. A case report

A rare primary choriocarcinoma of the stomach developed in a 71-year-old woman admitted with epigastric pain and weight loss. Brushing smears revealed highly atypical malignant cells with bizarre nuclei and prominent nucleoli. Multiple histologic sections revealed pure choriocarcinoma. Human chorionic gonadotropin and keratin were demonstrated in malignant cells by immunohistochemistry.

Decisive role of intermediate filament typing of tumor cells in the differential diagnosis of difficult fine needle aspirates

Thirty-six diagnostically difficult fine needle aspirates from enlarged lymph nodes and malignant soft tissue tumors, containing tumor cells with scanty or no obvious light microscopic features indicative of their differentiation, were assessed by a panel of six cytopathologists. Their diagnoses were recorded and then compared with the definitive diagnosis established by combining the cytologic findings with the results of intermediate filament typing of tumor cells in the smears using monoclonal antibodies specific for each filament type. The results show that use of these antibodies can markedly improve the accuracy of the cytologic diagnosis of tumor type as well as revise or prevent erroneous cytologic diagnoses in difficult cases. This pertains especially to the differential diagnoses of carcinoma versus malignant lymphoma, carcinoma versus malignant melanoma, carcinoma versus sarcoma and squamous carcinoma versus carcinoma of simple epithelia. Intermediate filament typing of tumor cells in aspirates as an objective histogenetic criterium makes the differential diagnosis of the difficult aspirates much more reliable and reproducible, provided that appropriate questions are asked, monoclonal antibodies with well-defined specificities are used and the antigenicity of the intermediate filaments in smears is preserved.

Diagnosis of orbital tumors by aspiration biopsy guided by computerized tomography

Thin-needle aspiration biopsy (TNAB) was performed on 22 patients with orbital tumors. Nine patients were studied before the introduction of computed tomography (CT) and only two cytologic diagnoses could be established. Thirteen aspiration biopsies guided by CT were successful. The technique of the CT-guided TNAB of orbital tumors is described. The cytologic features combined with the clinical data made it possible to diagnose precisely 10 malignant orbital tumors that were either metastatic or primary. Two meningiomas and one abscess were also identified. There were no complications. The TNAB of orbital tumors under CT guidance appears to offer several significant benefits to the patients.

A 19-year follow-up of multiple juvenile hyaline fibromatosis

Nineteen years observation of two siblings with multiple juvenile hyaline fibromatosis is presented. This entity was described 14 years ago. It is concluded that this disease can be effectively controlled by surgical excision of all newly discovered subcutaneous tumors.

Thin-needle aspiration biopsy of the prostate

The authors summarize the current status of thin-needle aspiration biopsy of the prostate and evaluate the accomplishments and limitations of this method of diagnosis. Historical developments, indications, technique, contraindications, complications, cytology of aspirates, diagnostic efficacy of aspirates, and grading of prostatic carcinomas are discussed.

Fine needle aspiration biopsy cytology of chondrosarcoma

Fine needle aspirates of ten chondrosarcomas were evaluated, and the cytologic features of this tumor were described. Some malignant cells in the smears of chondrosarcoma resembled cells of an epithelial origin and could be misinterpreted as carcinoma cells. The morphologic features described for chondrosarcoma should be helpful in avoiding such a diagnostic error.

Fine needle aspiration cytology of intraocular malignant melanoma

The techniques used for fine needle aspiration biopsy of 19 intraocular tumors clinically suspected to be malignant melanomas are described. Aspirates of 16 tumors yielded adequate material for the cytologic diagnosis of malignant melanoma. Malignant cells of the epithelial type and of a spindle shape were found in the smears. The main cytologic features of the epithelial-type cells were eccentrically located nuclei, distinct nucleoli, binucleation and multinucleation. The spindle-shaped cells, dispersed or arranged in clusters, were characterized by centrally placed, oval or rodlike nuclei, with or without nucleoli. Three types of smears were distinguished: (1) those with a predominance of epithelial-type cells, (2) those with a predominance of spindle-shaped cells and (3) those with mixed epithelial-type and spindle-shaped cells. Our observations prove that precise morphologic diagnosis of intraocular malignant melanoma and its cellular types can be established by fine needle aspiration biopsy. However, we do not advocate fine needle aspiration biopsy as a routine diagnostic procedure in all intraocular melanomas. This method should be reserved for only cases that cannot be definitely diagnosed by conventional techniques or in which the cellular type of melanoma must be defined in order to choose the proper method of treatment.

Pilomatrixoma: a pitfall in the aspiration cytology of skin tumors

The aspirates from six tumors of pilomatrixoma were cytologically misinterpreted. The fine needle aspiration findings of these six tumors are described. The common cytologic features of pilomatrixoma are clusters of tightly arranged cells and numerous single naked nuclei. The nuclei of cells in clusters as well as the naked nuclei are vesicular, with evenly distributed chromatin and distinct nucleoli. In addition, "ghost" cells and multinucleated giant cells present in some smears can support the cytologic diagnosis of pilomatrixoma.

Fine needle aspiration cytology of malignant melanoma of the skin

Fifty malignant melanomas of the skin were aspirated with a fine needle, and the cytomorphologic features of the smears were evaluated. An attempt was made to establish the frequency of morphologic features found in melanoma cells. The following features were regarded as frequent: lack of cohesiveness between the malignant cells; binucleated, multinucleated and giant cells; and intranuclear "vacuoles." The nuclei usually had a regular outline, and the nuclear chromatin was evenly distributed. The majority of the smears contained a mixture of epithelial-type and spindle cells. The nuclei of the epithelial-type cells were usually in an eccentric position. The morphologic features of malignant cells in smears, as described, can be helpful in making the preoperative cytologic diagnosis of nonpigmented malignant melanoma of the skin.

Fine needle aspiration cytology of metastatic myxopapillary ependymoma

The cytologic features of metastatic myxopapillary ependymoma were described. The cytologic material obtained from a metastatic subcutaneous nodule by the thin needle aspiration technique was examined by light and electron microscopy.

[Ultrastructure of ependymoma myxopapillare]

The results of histological and ultrastructural investigations of a tumour of the type of myxopapillary ependymoma growing initially extradurally in the end-part of the vertebral canal are reported. The patient has been observed for 13 years. During the disease several recurrences and distant metastases outside the central nervous system were observed. Histological examinations were carried out of the primary tumour and recurrences or metastases and always an evident papillary structure of tissue was found with characteristic "oedematous" stroma. In submicroscopic investigations attention was called to the stroma and to the ultrastructure of neoplastic cells. Slit-like spaces with numerous microvilli protruding into their lumen were observed between the neoplastic cells lying pallisade-like on the surface of papillae. These slits seemed on cross-sections to be minute tubular structures. This submicroscopic feature was not paid attention to in two previous papers discussing the ultrastructure of myxopapillary ependymoma.

The morphology of cells in effusions settled on glass

The cells of human body cavity fluids were examined by light microscopy and with a scanning electron microscope after settling on the surface of glass. Some differences in behavior of various cell types were noticed. The histiocytes, a few minutes after settling, began to spread, and thin processes later extended from their cytoplasm. Extension of mesothelial cells was observed a few hours after settling, and was not proceeded by flattening. The flattening of neutrophils occurred soon after settling, and was not followed by extension. The other cells encountered in effusion, both benign and malignant, did not change their shape even up to 12 hours after the time of settling. The differences in behavior after the settling of various cell types encountered in human effusions is discussed in relation to their biological properties.

The surface coat of the human effusion cells

Cancer cells of human effusions have a prominent surface coat clearly demonstrated by ruthenium red staining. The cancer cells forming clumps are usually interconnected with each other by gap junctions which is expressed by a free penetration of the ruthenium red through the majority of the junctions. The benign cells encountered in human effusions are also covered with the surface coat, which, however, is usually thinner in comparison to the coat observed on the cancer cells.

Transmission and scanning electron microscopic studies of cells in effusions

The transmission (TEM) and scanning electron microscopic (SEM) features of cancer cells and benign cells from human effusions were described. Both in the TEM and the SEM the following cell types were indentified; mesothelial cells, histiocytes, lumphocytes, eosinophilic leukocytes, neutrophilic leukocytes, plasma cells, erthrocytes and cancer cells. The ultrastructure of malignant cells originating from cancers most commonly metastisizing to the serous body cavities was described in detail. Both the TEM and the SEM clearly demonstrated fundamental differences between the surfaces of the cancer cells and benign cells in body cavity fluids: cancer cells were covered by numerous microvilli, while non-neoplastic cells were not. The approach described in this paper can be used for purposes of cytologic diagnosis in difficult preselected cases and may also have some important theoretical implications.

Cytodiagnosis of acinic cell carcinoma. Ultrastructural study of material obtained by fine needle aspiration biopsy

The material obtained by fine needle aspiration biopsy from a metastatic acinic cell carcinoma was evaluated by light and electron microscopy. A preliminary diagnosis of acinic cell carcinoma established by light microscopy was confirmed by electron microscopic study. Glandular arrangement of cancerous cells and the presence of a specific type of secretory granules in their cytoplasm were the most characteristic ultrastructural features of the acinic cell carcinoma.