Malignant phyllodes tumor metastatic to the forearm: a case report

We describe the cytological features of a malignant phyllodes tumor, in a 40-yr-old female, that metastasized to the forearm, and we correlate these findings with the criteria suggested by other authors for predicting the clinical and metastatic behavior of this tumor. The diagnosis of metastasis was based on fine-needle aspiration (FNA) cytology. One year prior, the patient had undergone mastectomy of the left breast for malignant phyllodes tumor, as proven by histopathology. The patient then presented with right forearm swelling, 1 yr later. FNA cytology was performed, and the diagnosis was metastatic malignant phyllodes tumor. Histologic review of the breast tumor revealed stromal overgrowth, which is the most important histologic criterion for predicting the metastatic behavior of malignant phyllodes tumor as reported by some authors.

Solid and papillary epithelial neoplasm of the pancreas. Report of a case with diagnosis by fine needle aspiration cytology

BACKGROUND

Solid and papillary epithelial neoplasm of the pancreas is a distinct clinicopathologic entity. It has a benign clinical course, and surgical resection can be curative.

CASE

A 17-year-old female presented with a mass measuring about 12 cm in the epigastrium and left hypochondrium. Fine needle aspiration cytology (FNAC) showed papillae with a central fibrovascular core and lined with many layers of bland-appearing cells exhibiting nuclear grooving. These features, along with ultrasound and computed tomographic findings, led to an accurate preoperative diagnosis.

CONCLUSION

In the setting of typical clinical and radiologic findings, it is possible to make a correct preoperative diagnosis by FNAC. Doing so has important implications for management.

Fine needle aspiration cytology of adenoma of the nipple. A case report

BACKGROUND

Adenoma (papillary adenoma, florid papillomatosis, subareolar duct papillomatosis, erosive adenomatosis) of the nipple is an uncommon lesion and can be mistaken clinically for Paget's disease and pathologically be misinterpreted as an adenocarcinoma.

CASE

A case of adenoma of the nipple was studied by cytology and histopathology.

CONCLUSION

Recognition of this benign lesion on cytology will prevent unnecessary radical surgery. Local excision alone suffices.

Infarction after fine needle aspiration. A report of four cases

BACKGROUND

Fine needle aspiration (FNA) is a well-established and safe method for the rapid diagnosis of palpable and deep-seated masses. A few clinically important complications, including bleeding, pneumothorax, infection and inflammatory reactions, result from FNA. Little attention has been focused on tissue changes resulting from FNA. In a small number of cases FNA has been followed by varying degrees of necrosis. This has occurred in thyroid nodules, salivary glands, breast fibroadenomas, lymph nodes and renal cell carcinoma.

CASES

Four cases of infarction followed FNA biopsy. All 4 (1 papillary carcinoma of the thyroid, 1 pleomorphic adenoma of the parotid gland and 2 fibroadenomas of the breast) were diagnosed by FNA. Subsequent histologic study of the surgical specimens revealed massive necrosis of the neoplasms.

CONCLUSION

Necrosis associated with infarction may cause diagnostic problems in two settings. FNA yielding necrotic debris may result in a false negative diagnosis in repeat aspiration. Alternatively, post-FNA infarction may obscure the nature of a neoplasm diagnosed by FNA, making histologic confirmation difficult.

Role of fine needle aspiration cytology as the initial modality in the investigation of thyroid lesions

OBJECTIVE

To study the utility of fine needle aspiration (FNA) cytology as the initial modality in the investigation of thyroid lesions.

STUDY DESIGN

Fine needle aspiration biopsies performed on patients presenting with diffuse or nodular thyroid enlargement and solitary thyroid nodules at the Goa Medical College Hospitals, Bambolim Goa, India, from January 1986 to June 1993, were reviewed. Two thousand four biopsies were performed on 1,992 patients, with 12 patients undergoing repeat FNA biopsy at different times due to an inconclusive primary result. These repeat biopsies were also inconclusive and were excluded from the series, leaving 1,992 cases. Two hundred thirty-eight of these 1,992 cases underwent surgery, either excision of the nodule or some form of thyroidectomy for a cytologically suspicious diagnosis, compression symptoms or cosmetic reasons, and a cytohistopathologic correlation was established in these cases. Twenty-five of the 238 cases that had inadequate cytologic findings were excluded, and the accuracy was studied in the remaining 213 cases.

RESULTS

The results of FNA classified 1,557 (78.16%) of these cases as benign, 151 (7.58%) as suspicious, 30 (1.51%) as malignant and 254 (12.75%) as unsatisfactory. Cytohistopathologic correlation was established in 238 cases, which were operated on. Nine (5.5%) of 163 cases with an FNA diagnosis of benign, 10 (26.3%) of 38 cases with an FNA diagnosis of suspicious and 11 (91.67%) of 12 cases with an FNA diagnosis of malignant were histologically malignant.

CONCLUSION

FNA biopsy of the thyroid can be used effectively as the initial modality in the evaluation of thyroid lesions, both nodular and diffuse. It is very useful in detecting neoplastic foci in multinodular goiter and also in evaluating solitary thyroid nodules.

Fine needle aspiration of the spleen in hairy cell leukemia. A case report

Hairy cell leukemia (HCL), or leukemic reticuloendotheliosis, first described by Bouroncle in 1958, is a chronic lymphoproliferative disorder of B-cell origin that is manifest primarily in the blood, marrow and spleen. The hairy cells often contain a tartrate-resistant acid phosphatase (TRAP) isoenzyme and show prominent cytoplasmic projections. We report a rare case of hairy cell leukemia wherein the total white blood cell count in the peripheral blood was 20 x 10(9)/L, there were hairy cells in the peripheral blood, and the bone marrow aspirate was a dry tap. Fine needle aspiration of the spleen was performed. The splenic smears showed a monotonous population of abnormal lymphoid cells, some with the hairlike cytoplasmic projections. TRAP staining was positive. HCL must be differentiated from splenic B-cell lymphoma with circulating villous lymphocytes.

Extralobar bronchopulmonary sequestration: a case report

Bronchopulmonary sequestration of the lung is a rare but well recognised congenital abnormality, which is clinically important because of the potential for medical and surgical complications. We report a case of extralobar bronchopulmonary sequestration on the left side in a newborn infant.

Antenatal ultrasonic diagnosis of Meckel Gruber syndrome (a case report with review of literature)

Meckel Gruber syndrome is a rare autosomal recessive disorder with major characteristic features consisting of occipital encephalocele, polydactyly and polycystic kidneys along with other associated malformation. Antenatal ultrasonic examination can establish the correct diagnosis by identifying at least two of the major features described. The antenatal ultrasonic findings and pathology of this uncommon entity are discussed.