Mesenchymal neoplasms: Is it time for cytology? New perspectives for the pre-operative diagnosis of soft tissue tumors in the molecular era

Hepatic Angiosarcoma with eosinophilia: A Case Report and Literature Review

Background

Hepatic angiosarcoma is an extremely rare, uncontrollable tumor with strong invasion, high mortality rate, and extremely poor prognosis. There is first report on hepatic angiosarcoma accompanied by eosinophilia.

Case Presentation

A woman with a chief complaint of poor appetite for about 3 months presented to a local hospital with a liver mass. Laboratory examination revealed a significant increase in eosinophils count was 9.58% in the serum. Abdominal MRI revealed multiple focal high-density lesions in the liver and spleen, and cranial MRI revealed multiple high-density shadows in the skull. Laparoscopic biopsy revealed a hepatic angiosarcoma and targeted treatment with Anlotinib was performed. Two months later, the patient died of splenic rupture and bleeding.

Conclusion

Hepatic angiosarcoma often has no specific clinical manifestations, and we found that this case can lead to an increase in eosinophils, which is worth the attention of clinical physicians.

PRAME Immunocytochemistry for the Diagnosis of Melanoma Metastases in Cytological Samples

(1) Background: Fine-needle aspiration cytology is often used for the pre-operative diagnosis of melanoma metastases. The diagnosis may not be confidently established based on morphology alone, and immunocytochemistry is mandatory. The choice of the most advantageous immunocytochemical antibodies is critical, as the sample may be scant, and the presence of pigmented histiocytes may be confounding. However, the diagnostic performance of melanocytic markers in this setting is poorly investigated. Moreover, PRAME (preferentially expressed antigen in melanoma) recently emerged as a novel marker for the diagnosis of melanoma. The current work aimed to evaluate the sensitivity and specificity of PRAME for the diagnosis of melanoma metastases in cytological samples, compared to other melanocytic markers. (2) Methods: PRAME, S100, Melan-A, HMB45 and SOX10 were tested on cell block sections of 48 cases of melanoma metastases diagnosed from cytological samples, and 20 cases of reactive lymphadenopathy. (3) Results: S100 and SOX10 showed the highest sensitivity (100%), while the sensitivity of PRAME was 85.4%. PRAME, Melan-A, SOX10 and HMB45 showed a specificity of 100%, while the specificity of S100 was lower (85%), as it marked some histiocytes. (4) Conclusion: PRAME immunocytochemistry is highly specific for the diagnosis of melanoma metastasis from a cytological sample, but is less sensitive compared with other melanocytic markers.

Primary desmoplastic small round cell tumor of the submandibular gland: a case report and literature review

Background

Desmoplastic small round cell tumor (DSRCT) is a sporadic, highly malignant tumor with a poor prognosis. The abdomen and pelvis have been reported as the primary localization sites. However, to the best of our knowledge, there are few reports on primary DSRCT in the submandibular gland.

Case presentation

We report a case of a 26-year-old Chinese man with a mass in the right submandibular gland. Imaging studies showed a hypoechoic mass in the right submandibular region. Intraoperative pathology revealed that the tumor tissue was composed of small round tumor cells and a dense desmoplastic stroma. On immunostaining, the tumor cells showed markers of epithelial, mesenchymal, myogenic, and neural differentiation. The EWSR1 gene rearrangement was detected by fluorescence in situ hybridization. Based on the overall morphological features and immunohistochemical findings, a final diagnosis of DSRCT was made. The patient was treated with comprehensive anti-tumor therapy mainly based on radiotherapy and chemotherapy.

Conclusions

DSRCT is an uncommon malignant neoplasm with rare submandibular gland involvement. In this report, we have described a case of DSRCT in the submandibular gland and reviewed the literature on DSRCT over the past 5 years. Considering the importance of differential diagnosis between DSRCT, especially with rare extra-peritoneal involvement, and small round blue cell tumors, a full recognition of the clinicopathological features will help to better diagnose this neoplasm.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13000-021-01183-3.

Differential diagnosis of lipoma and atypical lipomatous tumor/well-differentiated liposarcoma by cytological analysis

BACKGROUND

Adipocytic tumors are the most common soft tissue tumors, with lipomas and atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDL), which comprise most cases. Preoperative differential diagnosis of lipoma or ALT/WDL can provide important information for decisions regarding treatment. We evaluated the cytological findings of 20 cases of lipoma and ALT/WDL.

METHODS

Fluorescence in situ hybridization (FISH) was performed on formalin-fixed paraffin-embedded specimens (FFPE) to examine mouse double minute 2 homolog (MDM2) amplification in all cases. Tissue samples were collected from the center of the surgical materials, stained with Pap, and evaluated for 12 cytological parameters by six cytotechnologists.

RESULTS

The findings regarding large atypical cells, multinucleated cells, and nuclear pleomorphism were highly concordant among the cytotechnologists and were associated with MDM2 amplification. Large atypical cells, considered a highly specific feature of ALT/WDL, were not observed in lipoma cases. However, the sensitivity of the large atypical cell findings was not high (67%); therefore, comprehensive evaluation of multinucleated cells and pleomorphism is crucial for predicting ALT/WDL diagnosis. FISH of MDM2 on Pap-stained specimens was performed in four cases. In two, the results were similar to those of MDM2 FISH performed on FFPE sections and were reproducible, whereas in the other two, the signal could not be evaluated because of the strong background coloration.

CONCLUSIONS

Cytology specimens may be useful for the preoperative diagnosis of adipocytic tumors, particularly if the FISH conditions for Pap-stained specimens and the detection accuracy of MDM2 amplification can be improved.

Diagnostic performance of melanocytic markers for immunocytochemical evaluation of lymph-node melanoma metastases on cytological samples

AIMS

The diagnosis of metastatic cutaneous melanoma (CM) on lymph node fine needle aspiration samples may be challenging and usually requires confirmation by immunocytochemistry. However, the cytological material could be too scant to order a broad panel of markers. In this case, the pathologist is forced to choose the most advantageous antibodies. The most commonly used melanocytic markers include S100, Melan-A, HMB45 and SOX10 but their diagnostic yield on cytological samples has been poorly studied. The current work aimed to evaluate the diagnostic performance of melanocytic markers when applied to cell blocks obtained from fine needle aspiration cytology (FNAC) of lymph node metastases from CM.

METHODS

S100, Melan-A, HMB45 and SOX10 were tested on cell block sections of 38 lymphnode metastases from CM diagnosed by cytology. A combined score was built to evaluate each immunostaining, considering the intensity of the staining and the percentage of stained neoplastic cells.

RESULTS

S100 and SOX10 revealed a higher sensitivity (100%) than Melan-A and HMB45 for the diagnosis of metastatic CM. Furthermore, SOX10 emerged as the melanocytic marker with the best staining performance.

CONCLUSION

SOX10 has a 100% detection rate and the most easily interpretable staining pattern compared with other melanocytic markers. Therefore, it is strongly recommended that SOX10 is included in the minimal immunocytochemical panel for the diagnostic evaluation of lymph node FNAC in patients with suspected CM metastasis.

Cytologic diagnosis of metastatic melanoma by FNA: A practical review

Malignant melanoma (MM) is a highly aggressive neoplasm with a growing worldwide incidence. It is not uncommon that the disease is already metastatic at the time of the first diagnosis. Regional lymph nodes and skin are the first and most common metastatic sites, followed by distant visceral sites (lungs, liver, and central nervous system) and bone. In this clinical setting, fine-needle aspiration (FNA) often represents the first diagnostic approach. FNA is a useful tool to obtain a rapid and accurate diagnosis, in conjunction with ancillary techniques and molecular analysis, as recommended by recent guidelines. The aim of this review was to describe the cytomorphology, immunocytochemical tools, and molecular tools used for the diagnosis of MM metastases on FNA.

Atypical cytological presentation of granular cell tumour: Tumour-associated fibrosis may affect fine-needle aspiration cytology accuracy

The cytological features of granular cell tumour (GCT) are generally quite typical but, in some cases, the fine needle aspiration cytology (FNAC) diagnosis of GCT may be difficult or impossible because of unusual sites of onset or equivocal cytological features. In this report, two GCTs with atypical FNAC features are described in order to investigate the causes and provide possible diagnostic tips. From a series of nine histologically proven GCTs, two inconclusive FNAC cases were retrieved. Smears were poorly cellular showing isolated naked nuclei, anisonucleosis, granular chromatin and occasional small nucleoli. The background was finely granular in one case. Histological controls of these cases revealed marked fibrosis. Tumour-associated fibrosis in GCT is variable and does not seem to influence clinical behaviour but it influences the harvest and the integrity of granular cells collected by FNAC. When GCT smears are poorly cellular, attention should be paid to the granular background and to the few granular cells, if any, as they might be the only features to suggest a GCT.

Giant cell-rich extrapleural solitary fibrous tumor: Cytological findings and differential diagnosis of a rare neoplasm

Extrapleural solitary fibrous tumor (ESFT) is a rare neoplasm with a variable biological behavior that may occur almost everywhere in the body, as it has been reported in head and neck, back, retroperitoneum, inguinal region and more. The diagnosis of ESFT may be challenging, especially in case of its morphological rare variants such as giant cell-rich ESFT. Fine-needle aspiration cytology (FNAC) is a rapid, poorly invasive, safe diagnostic technique, which is recently proving useful for the preoperative diagnosis of mesenchymal neoplasms. Herein we report a case of a FNAC diagnosis of giant cell-rich ESFT, focusing on its morphological and immunocytochemical characteristics, and showing how cytology may be an effective tool in the preoperative diagnosis of mesenchymal neoplasms, allowing the correct surgical management of the patient.