DNA cytometry of soft tissue tumours with TV image-analysis system

Diagnosis of soft tissue tumors by fine-needle aspiration with combined cytopathology and ancillary techniques

The diagnosis of mesenchymal neoplasm by fine-needle aspiration biopsy (FNAB) has presented a diagnostic challenge. Most reports claim an accuracy approaching 95%, but while they distinguish benign and malignant lesions, the most problematic group, the intermediary malignant group, is omitted. The purpose of this study was to determine whether rapid cytologic diagnosis of soft-tissue tumors could guide surgeons in therapeutic decisions without the need for a tissue biopsy. Ninety-four FNA cytologic specimens were examined by the National Soft Tissue Consortium of Hungary and compared with the corresponding histology. Ordinary lipomas were excluded. Morphologic evaluation was supplemented by ancillary techniques such as fluorescence in situ hybridization (FISH), DNA cytometry, and immunocytochemistry. From a practical clinicopathological point of view, the cases were grouped in the following categories: 1) tumors with definitive diagnosis: a) high-grade malignant neoplasms (high-grade sarcomas, metastatic carcinomas, lymphoma), b) tumors with precise histogenetic origin by cytogenetics, c) benign tumors; 2) tumors of questionable nature. In the first group there were 74 tumors: 22 high-grade sarcomas, six metastatic carcinomas, one malignant lymphoma, 16 malignant tumors in which the precise histogenetic origin could be established by cytogenetic studies, and 29 benign soft-tissue tumors other than lipomas. In the second group there were 20 tumors comprising benign and malignant soft tissue tumors of low grade, wherein the precise nature of the neoplasm could not be established with confidence on cytologic study, even using ancillary techniques. FNAB of soft-tissue tumors combined with ancillary techniques should be considered a viable diagnostic technique for therapeutic protocols. Although the second group is fairly large, we have reliable, well-characterized categories which provide great freedom for preoperative and surgical treatment, thus providing the best chance for healing.

Benign mesenteric lipoblastoma

An unusual case of benign intraperitoneal lipoblastoma in a 10-months-old girl is presented. Cytologically and histologically, the tumor had no malignant features. By means of DNA cytometry, it was regarded as diploid without signs of malignancy and of low proliferative potential. The tumor was treated by complete surgical excision.

Cytological vs histological evaluation of percutaneous biopsies

Fine-needle aspiration cytology yields sufficient diagnostic accuracy to compete with histology from punch biopsy for cancers of the lung and the prostate. For tumors of the breast, pancreas, thyroid, salivary glands, and kidneys, fine-needle aspiration cytology yields sufficient sensitivity and specificity when performed preoperatively; the exact tumor typing will follow surgical excision. In palpable lymph nodes, adrenals, and lungs, fine-needle aspiration biopsy is sufficient if metastases from a known primary tumor are suspected. Indications for punch biopsies and histological investigation are tumors of the liver, posterior and anterior mediastinum, retroperitoneum, soft tissues, and bone. In these conditions, cytological investigation alone provides insufficient typing accuracy. Suspected lymphomas in a retroperitoneal or mediastinal location should be punctured and may be classified from punch biopsies if the node is not easily reached by surgery. There are no indications for percutaneous biopsies in tumors of the skin, testes, and ovaries. Percutaneous fine-needle aspiration biopsies in general are associated with significantly lower complication rates than punch biopsies.