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Khattab RA, Rowe JJ, Booth CN, Sneige N, Fong N, Pantanowitz L, Oshilaja O, Brainard JA, Downs-Kelly EP, Dawson A, Sturgis CD. Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses. Diagn Cytopathol 2019; 47:1100-1118. [PMID: 31343114 DOI: 10.1002/dc.24288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/06/2022]
Abstract
The Uniform Approach to Breast Fine Needle Aspiration Biopsy was put forward by a learned group of breast physicians in 1997. This landmark manuscript focused predominantly on diagnosis and reporting of mammary epithelial lesions. Today, most American practitioners turn initially to core biopsy rather than aspiration biopsy for the first line diagnosis of solid breast lesions; however, recent efforts from the International Academy of Cytology have produced a system called the Standardized Reporting of Breast Fine Needle Aspiration Biopsy Cytology (colloquially labeled in 2017 as the "Yokohama System"), suggesting a new interest in breast fine needle aspiration (FNA), especially in resource limited settings or clinical practice settings with experienced breast cytopathologists. Fibroepithelial lesions of the breast comprise a heterogeneous group of biphasic tumors with epithelial and stromal elements. Mesenchymal lesions of the breast include a variety of neoplasms of fibroblastic, myofibroblastic, endothelial, neural, adipocytic, muscular, and osteo-cartilaginous derivations. The cytology of mesenchymal breast lesions is infrequently described in the literature and is mainly limited to case reports and small series. This illustrated review highlights the cytologic features of fibroepithelial and mesenchymal mammary proliferations and discusses differential diagnoses and histomorphologic correlates.
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Affiliation(s)
- Ruba A Khattab
- Department of Pathology, University Hospitals of Case Western Reserve University, Cleveland, Ohio
| | - J Jordi Rowe
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | - Nour Sneige
- Department of Pathology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | - Nancy Fong
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Andrea Dawson
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
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Choudhary Z, Gupta P, Malhotra P, Bhardwaj M, Sharma PK. Granular Cell Tumour of the Chest Wall: FNA Diagnosis with a Review of Literature and Elaboration of Cytological Mimickers. J Clin Diagn Res 2017; 11:ED01-ED03. [PMID: 28969141 DOI: 10.7860/jcdr/2017/29123.10337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/26/2017] [Indexed: 11/24/2022]
Abstract
Granular Cell Tumours (GCTs) are uncommon tumours which can be confused with other benign soft tissue tumours on clinical examination. Fine Needle Aspiration Cytology (FNAC) plays a significant role in their diagnosis. There are certain cytological mimickers of GCTs so a cytopathologist must be aware of its characteristic cytomorphology. These tumours can be present anywhere on the body; however, chest wall is one of the uncommon sites. We present a case of GCT present on the chest wall in an elderly male as a subcutaneous nodule. We have discussed the common cytological differential of GCTs, features of malignant GCTs along with cytomorphological and immunohistochemical features.
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Affiliation(s)
- Zeba Choudhary
- Senior Resident, Department of Pathology, Pgimer, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Prajwala Gupta
- Associate Professor, Department of Pathology, Pgimer, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Purnima Malhotra
- Specialist, Department of Pathology, Pgimer, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Minakshi Bhardwaj
- Professor, Department of Pathology, Pgimer, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Prafull Kumar Sharma
- Professor, Department of Dermatology, Pgimer, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Wang YH, Lee MY. Granular cell tumor in male breast masquerading as atypical apocrine neoplasm: A potential diagnostic pitfall in fine needle aspiration cytology. Diagn Cytopathol 2016; 44:612-5. [DOI: 10.1002/dc.23475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/22/2016] [Accepted: 03/09/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Yeh-Han Wang
- Department of Anatomic Pathology; Keelung Hospital, Ministry of Health and Welfare; Keelung Taiwan
- Department of Pathology and Laboratory Medicine; Koo Foundation Sun Yat-Sen Cancer Center; Taipei Taiwan
- School of Medicine, National Yang-Ming University; Taipei Taiwan
| | - Ming-Yuan Lee
- Department of Pathology and Laboratory Medicine; Koo Foundation Sun Yat-Sen Cancer Center; Taipei Taiwan
- School of Medicine, National Yang-Ming University; Taipei Taiwan
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Khurana U, Handa U, Mohan H. Fine-needle aspiration cytology of cutaneous granular cell tumor: Report of two cases with special emphasis on cytological differential diagnosis. J Cytol 2016; 33:30-3. [PMID: 27011439 PMCID: PMC4782400 DOI: 10.4103/0970-9371.175497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Granular cell tumors (GCTs) are uncommon neoplasms with recently postulated origin from Schwann cell or neural crest. It can appear in different parts of the body and is most commonly found in the tongue. The cutaneous presentation is not that uncommon. Fine needle aspiration cytology (FNAC) has been suggested to be the diagnostic modality of choice. It will help to differentiate benign tumors from malignant ones and to differentiate GCT from frequent misdiagnoses such as granular histiocytic reaction, xanthogranuloma, rhabdomyoma, oncocyte rich lesions, alveolar soft part sarcoma (ASPS), epithelioid sarcoma, and carcinoma. We report two cases of GCT who presented with subcutaneous swellings in the right thigh and the left lumbar region for 24 months and 18 months, respectively. In the first case, a cytodiagnosis of chronic inflammation showing histiocytes was suggested while GCT was found in the second case. Subsequent histologic examination of the first case and immunocytochemistry in the second case gave the confirmatory diagnosis of GCT.
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Affiliation(s)
- Ujjawal Khurana
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Harsh Mohan
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
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Koshy J, Schnadig V, Nawgiri R. Is fine needle aspiration cytology a useful diagnostic tool for granular cell tumors? A cytohistological review with emphasis on pitfalls. Cytojournal 2014; 11:28. [PMID: 25379050 PMCID: PMC4220426 DOI: 10.4103/1742-6413.143304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/21/2014] [Indexed: 12/29/2022] Open
Abstract
Background: Granular cell tumors (GCT) formerly known as Abrikossoff tumor or granular cell myoblastoma, are rare neoplasms encountered in the fine needle aspiration (FNA) service. Named because of their highly granular cytoplasm which is invariably positive for the S-100 antibody, the classic GCT is thought to be of neural origin. The cytomorphological features range from highly cellular to scanty cellular smears with dispersed polygonal tumor cells. The cells have abundant eosinophilic granular cytoplasm, eccentric round to oval vesicular nuclei with small inconspicuous nucleoli. The fragility of the cells can result in many stripped nuclei in a granular background. The differential diagnosis occasionally can range from a benign or reactive process to features that are suspicious for malignancy. Some of the concerning cytologic features include necrosis, mitoses and nuclear pleomorphism. Methods: We identified 6 cases of suspected GCT on cytology within the last 10 years and compared them to their final histologic diagnoses. Results: Four had histologic correlation of GCT including one case that was suspicious for GCT on cytology and called atypical with features concerning for a malignant neoplasm. Of the other two cases where GCT was suspected, one showed breast tissue with fibrocystic changes, and the other was a Hurthle cell adenoma of the thyroid. Conclusions: These results imply that FNA has utility in the diagnosis of GCT, and should be included in the differential diagnoses when cells with abundant granular cytoplasm are seen on cytology. Careful attention to cytologic atypia, signs of reactive changes, use of immunohistochemistry, and clinical correlation are helpful in arriving at a definite diagnosis on FNA cytology.
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Affiliation(s)
- Jason Koshy
- Address: Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0548, United States
| | - Vicki Schnadig
- Address: Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0548, United States
| | - Ranjana Nawgiri
- Address: Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0548, United States
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Kawasaki T, Nakamura S, Sakamoto G, Kondo T, Tsunoda-Shimizu H, Ishii Y, Nakazawa T, Mochizuki K, Yamane T, Inoue M, Inoue S, Katoh R. Neuroendocrine ductal carcinoma in situ of the breast: cytological features in 32 cases. Cytopathology 2011; 22:43-9. [DOI: 10.1111/j.1365-2303.2010.00742.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brown AC, Audisio RA, Regitnig P. Granular cell tumour of the breast. Surg Oncol 2010; 20:97-105. [PMID: 20074934 DOI: 10.1016/j.suronc.2009.12.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 10/24/2009] [Accepted: 12/02/2009] [Indexed: 11/29/2022]
Abstract
Granular cell tumour of the breast (GCTB) is a rare tumour which arises from Schwann cells. It is a largely benign tumour but in extremely rare cases can exhibit malignant characteristics. It poses a particular problem as it's characteristics can mimic breast carcinoma clinically, radiologically and macroscopically. This results in the potential misdiagnosis of breast carcinoma and over treatment of patients. Typically GCTBs are benign, solitary lesions but variations include malignant GCTBs, colocalisation with breast malignancies and multicentricity. These tumours can be investigated using mammography, ultrasound and magnetic resonance imaging. However none of these modalities have yet identified any GCTB specific characteristics. On pathological examination they can be identified using both microscopic and immunohistochemical features. The cells have a distinctive granular eosinophilic cytoplasm associated with typical nuclei and abundant lysosomes. Immunohistochemically they are positive for S100 protein, CD68 and neuron specific endolase (NSE). They are treated with wide local excision and while they may reoccur, are associated with a good prognosis.
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Affiliation(s)
- Anna C Brown
- Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
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Policarpio-Nicolas MLC, Le BH, Mandell JW, Lopes MBS. Granular cell tumor of the neurohypophysis: report of a case with intraoperative cytologic diagnosis. Diagn Cytopathol 2008; 36:58-63. [PMID: 18064694 DOI: 10.1002/dc.20646] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cytological techniques including touch and smear preparations are very useful diagnostic modality in the evaluation of central nervous system (CNS) lesions and, in many instances, may be effectively used as the sole modality of tissue preparation for intraoperative consultation. Cytologic preparations offer many advantages over frozen sections for CNS specimens. These include selective examination of multiple areas from small biopsy specimens, superior preservation and details of cellular morphology, fewer artifacts, faster results, and improved cost-effectiveness. We describe the cytologic diagnosis of a granular cell tumor (GCT) of the neurohypophysis in a 33-year-old male who presented with headache and blurred vision. CT scan revealed an enlarged sella with a 2.15 x 2.0 cm pituitary lesion. Transsphenoidal resection of the mass was performed and submitted for intraoperative consultation. Smears and touch preparations were made on a portion of the mass that showed uniform polygonal cells with round to ovoid nuclei and abundant eosinophilic granular cytoplasm. An intraoperative cytological diagnosis of "favor GCT" was rendered. The histologic sections of the remaining material confirmed the diagnosis. Although GCT of the neurohypophysis is very rare, a specific intraoperative cytological diagnosis is possible. We report the clinical, cytological, and pathological findings of a GCT affecting the neurohypophysis.
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Affiliation(s)
- Maria Luisa C Policarpio-Nicolas
- Department of Pathology, Division of Cytopathology, University of Virginia Health System, Charlottesville, Virginia 22908-0214, USA
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Abstract
Fine needle aspiration biopsy is a widely used technique for the initial diagnosis of mammary lesions. The majority of patients undergoing fine needle aspiration biopsy of a breast lesion will have a benign disease of the breast. This article provides a review of the cytomorphologic features in a variety of benign breast lesions,and discusses the commonly encountered differential diagnoses on aspiration biopsy. Topics discussed include inflammatory and reactive conditions, treatment-induced changes, pregnancy-related changes, benign proliferative lesions, and benign neoplasms of the breast.
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Affiliation(s)
- Pascale Hummel Levine
- Department of Pathology, New York University School of Medicine, New York, NY 10016, USA
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Rossi ED, Mule' A, Miraglia A, Cianfrini F, Zannoni GF, Fadda G. Granular cell tumour on conventional cytology and thin-layer smears. Cytopathology 2005; 16:259-61. [PMID: 16181314 DOI: 10.1111/j.1365-2303.2005.00286.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E D Rossi
- Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University, Rome, Italy
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Cangiarella J, O'Connell Mazzei E, Weg N, Limaye A, Waisman J. Aspiration biopsy in a case of apocrine adenocarcinoma with foam cells (myoblastomatoid or histiocytoid adenocarcinoma). Diagn Cytopathol 2002; 26:320-3. [PMID: 11992376 DOI: 10.1002/dc.10103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We found only one report of a case of apocrine adenocarcinoma with foamy cells diagnosed by aspiration biopsy. Herein, we describe a second case with cytologic, histologic, and immunohistochemical findings and discuss the differential diagnosis of foamy cells on aspiration smears obtained from mammary nodules.
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Affiliation(s)
- Joan Cangiarella
- Department of Pathology, New York University Medical Center, 550 First Avenue, Skirball West Tower, Suite 7S, New York, NY 10016, USA.
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