Cytologic findings in a fetal intracranial teratoma. A case report

Cytopathology of a primary follicular dendritic cell sarcoma of the liver of the inflammatory pseudotumor-like type

Follicular dendritic cell (FDC) sarcoma is an exceedingly uncommon tumor of lymph nodes and extranodal tissues. The inflammatory pseudotumor (IPT)-like variant of FDC sarcoma of intraabdominal location is considered a separate entity, with different clinical and pathological features than those of the classic FDC tumor. There have been only 12 cytological reports of FDC sarcomas in the literature. Two of them were metastases to the liver and, like our case, had features of IPT. Fine-needle aspiration biopsy (FNAB) and imprint and scrape cytology from the surgically excised tumor here reported revealed spindle tumor cells with moderate pleomorphism, nuclear grooves, prominent nucleoli, and cytoplasmic processes, admixed with inflammatory cells. To the best of our knowledge, this is the first cytology report of a primary hepatic FDC tumor. The cytological findings permit the recognition of this tumor. However, confirmation by inmunohistochemistry (IHQ) is mandatory for a definitive diagnosis.

Endoscopic biopsy interpretation difficulties in a congenital diffuse intracranial teratoma

INTRODUCTION

Congenital brain tumours are a rare entity that is nowadays often already recognised during pregnancy by ultrasound (US) and magnetic resonance (MR). Even though the definitive diagnosis is usually achieved by means of histological studies, in some cases the diagnosis may remain uncertain because of the malformative origin of this type of tumour.

CASE REPORT

We describe a patient with a diffuse congenital intracranial mass diagnosed by intrauterine US and foetal MR performed to further evaluate the lesion and the associated foetal hydrocephalus. After delivery by caesarean section, an endoscopic biopsy was performed. Several specimens were obtained and resulted in the diagnosis of primitive neuroectodermal tumour (PNET). Despite polychemotherapy, the tumour continued to enlarge and the patient died at 2 months of age. Post-mortem histological examination of the intracranial mass showed a diffuse intracranial teratoma.

CONCLUSION

Endoscopic biopsy specimen examination resulted in a diagnosis that was not confirmed by post-mortem findings. The scarce differentiation of teratoma components and their high variability in histomorphology as well as the huge size of the tumoral mass may limit the interpretation of endoscopic biopsy specimens, even when multiple and obtained from different areas.

Fine-needle aspiration cytology of a liver metastasis of follicular dendritic cell sarcoma

Follicular dendritic cell sarcoma (FDCS) is an uncommon neoplasm derived from FDCs in lymphoid tissue. Metastatic FDCS to the liver is rare. We present a case of a 65-yr-old woman who was referred to our institution 1 mo after splenectomy for FDCS of the spleen. An abdominal CT scan revealed a 2.0-cm liver lesion, which led to fine-needle aspiration (FNA) biopsy. Smears of the aspiration obtained were hypercellular showing a pleomorphic population of large oval to spindle-shaped tumor cells against a background of small mature lymphocytes, plasma cells, and necrotic debris. Tumor cells were arranged singly, in syncytial or fascicular patterns, and had a moderate amount of cytoplasm and indistinct cell borders. Nuclei had irregular nuclear membranes, finely granular to vesicular chromatin, and prominent nucleoli. Multinucleated and binucleated cells resembling Reed-Sternberg cells were noted occasionally. Mitotic figures, including atypical forms, were frequently identified. The diagnosis of "pleomorphic malignant spindle-cell neoplasm consistent with metastatic FDCS" was rendered and later confirmed by histological review and immunohistochemical staining of the subsequent liver resection specimen. Although cytological features of FDCS are characteristic, they are overlapping with those of many other tumors. We review the literature on this entity with emphasis on FNA cytomorphology, differential diagnosis, and immunohistochemical findings.

Transplacental and other routes of cancer transmission between individuals

Cancer in pregnancy is not rare, and the possibility of transmission of malignancy from mother to child, while infrequent, represents a clinical challenge for the primary pediatric hematologist-oncologist. The authors summarize all reported cases of vertically transmitted cancer and review other reported cases of person-to-person transfer of malignancy. As these cases represent a unique physiologic model of tumor transplantation, the biology of cancer transmission is discussed and provisional guidelines are given for the screening of infants born to women with cancer.