56
Correspondence
has cytoplasmic vacuoles with displacement of the nuclei towards the periphery, but without an intracytoplasmic inclusion dense body.1 Therefore, careful observation can lead to the detection of the rhabdoid component in cytological examination. A. Kagotani1, M. Ishida1, K. Yoshida, M. Iwai and H. Okabe Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Shiga, Japan References 1. Perez-Montiel D, Wakely PE Jr, Hes O, Michal M, Suster S. High-grade urothelial carcinoma of the renal pelvis: clinicopathologic study of 108 cases with emphasis on unusual morphologic variants. Mod Pathol 2006;19: 494–503. 2. Parwani AV, Herawi M, Volmar K, Tsay SH, Epstein JI. Urothelial carcinoma with rhabdoid features: report of 6 cases. Hum Pathol 2006;37:168–72. 3. Fukumura Y, Fujii H, Mitani K et al. Urothelial carcinoma of the renal pelvis with rhabdoid features. Pathol Int 2009;59:322–5. 4. Duvdevani M, Nass D, Neumann Y et al. Pure rhabdoid tumor of the bladder. J Urol 2001;166:2337. 5. Inagaki T, Nagata M, Kaneko M et al. Carcinosarcoma with rhabdoid features of the urinary bladder in a 2year-old girl: possible histogenesis of stem cell origin. Pathol Int 2000;50:973–8. 6. Kumar S, Kumar D, Cowan DF. Transitional cell carcinoma with rhabdoid features. Am J Surg Pathol 1992;16:515–21. 7. Harris M, Eyden BP, Joglekar VM. Rhabdoid tumour of the bladder: a histological, ultrastructural and immunohistochemical study. Histopathology 1987;11:1083–92.
Cerebellopontine angle schwannoma masquerading as malignant tumour in cytology fluid of cyst DOI:10.1111/cyt.12123
Dear Editor, Cerebellopontine angle tumours comprise 5–10% of all intracranial tumours in adults. Of
Correspondence: Dr P. Dey, Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India Tel.: +91-172-2755120; Fax: +91-172-2744401; E-mail: [email protected]
these tumours, 80% are vestibular schwannomas. The other less common tumours of this region include meningioma, ependymoma, choroid plexus papilloma and epidermoid cyst.1–3 We present a case of ancient schwannoma in the cerebellopontine angle that was misdiagnosed as a malignant tumour on cytology of cyst fluid. The patient was a 62-year-old woman whose chief complaint was progressive left-sided hearing loss. Magnetic resonance imaging (MRI) showed a solid and cystic space-occupying lesion at the cerebellopontine angle, measuring approximately 1.5 cm in diameter. There was no enhancement of the tumour on MRI. Intraoperatively, the aspirated cyst fluid was sent for cytology. The conventional and liquidbased cytology (LBC, SurePathâ) smears showed pleomorphic cells in small clusters. Individual cells were round to oval with a moderate amount of vacuolated cytoplasm. The nuclei showed moderate pleomorphism with prominent nucleoli (Figure 1a, b). No mitotic activity was noted on the fluid smear. Considering the significant nuclear pleomorphism of the cells, the cyst fluid was reported as positive for malignancy, possibly a metastatic tumour. No frozen section was undertaken at the time of operation as the cyst was completely removed. On histopathological examination, the tumour was found to be a typical ancient schwannoma with large areas of Antoni B morphology and pleomorphic cells as a result of long-standing degenerative changes (Figure 1c). The mitotic count of the tumour was 1/50 high-power field. Schwannoma, and particularly ancient schwannoma, is notorious for cellular pleomorphism.4 In the present case, significant enlargement and pleomorphism of the nuclei were the sources of the mistake. Moreover, all the cells in the cytology smears were round to oval rather than elongated and spindle shaped in morphology. Considering the age of the patient and the nuclear pleomorphism, we wrongly labelled this case as metastatic tumour. Involvement of the cerebellopontine angle region by metastatic tumour is rare, usually arising from the lung, breast or gastrointestinal tract.5 Metastatic tumours in this region are usually bilateral at the time of presentation. In the present case, unilateral involvement and the history of loss of hearing were important clues to the diagnosis of schwannoma. In summary, ancient schwannoma is an important source of error and the cytopathologist should be careful in reporting cerebellopontine angle tumours. © 2013 John Wiley & Sons Ltd Cytopathology 2015, 26, 50–60
Correspondence
(a)
(b)
2. Kohan D, Downey LL, Lim J, Cohen NL, Elowitz E. Uncommon lesions presenting as tumours of the internal auditory canal and cerebellopontine angle. Am J Otol 1997;18:386–92. 3. Moffat DA, Ballagh RH. Rare tumours of the cerebellopontine angle. Clin Oncol 1995;7:28–41. 4. Dey P, Mallik MK, Gupta SK, Vasishta RK. Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours and tumour like lesions. Cytopathology 2004;15: 32–7. 5. Preuss M, Stein M, Huegens-Penzel M, Kuchelmeister K, Nestler U. Metastatic tumours mimicking vestibular schwannoma. Acta Neurochir (Wien) 2008;150:915–9.
Utility of on-site cytological examination and cell block preparation in thyroid fine needle aspiration biopsy of metastatic carcinoma: report of two cases DOI:10.1111/cyt.12134
(c)
Figure 1. (a) Conventional preparation of cyst fluid showing loose clusters of cells with mild to moderate nuclear atypia (May–Gr€ unwald–Giemsa 91200). (b) Liquid-based cytology preparation of the cyst fluid showing a loose cluster of cells with enlarged pleomorphic nuclei (Papanicolaou 91200). (c) Histopathology section of the ancient schwannoma showing considerable nuclear enlargement and pleomorphism (haematoxylin and eosin 9440).
D. Gochhait, D. Chatterjee, A. Bal and P. Dey Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India References 1. Guevara N, Chays A, Bruzzo M et al. Cerebellopontine angle paraganglioma. Otol Neurotol 2003;24:469–72. Ó 2014 John Wiley & Sons Ltd Cytopathology 2015, 26, 50–60
Dear Editor, Fine needle aspiration biopsy (FNAB) of the thyroid is a reliable diagnostic tool for the diagnosis of primary and secondary neoplasms, whereas the identification of the origin of metastatic disease can sometimes be problematic.1 A good clinicopathological correlation before aspiration is important to prevent diagnostic difficulties. In this setting, on-site evaluation can be used in order to improve the adequacy of FNAB. In this way, preliminary information about the malignant potential of the lesion is provided and a decision is made to collect material for cell block histology.2 Here, we report two cases of metastatic lung adenocarcinoma to the thyroid that were reliably diagnosed by FNAB and immunocytochemistry applied on cell blocks. A 47-year-old man presented with a swelling in the right lobe of the thyroid. There was no significant history of any other diseases. Thyroid function tests were within normal limits. Ultrasound showed a 1.7-cm hypoechoic mass in the right lobe of the thyroid, and the remainder was unremarkable. The cellular smears comprised sheets and clusters of cells that were forming papillae or acini in a necrotic background. The cells had round, large, pleomorphic, irregularly
Correspondence: S. Guresci, MD, Sanatoryum Cad. Ardahan Sok. No 25, 06180 Kecioren, Ankara, Turkey Tel.: +90-312-356-90-00; Fax: +90-312-356-90-02; E-mail: [email protected]
57
Correspondence
(a)
(b)
2. Kohan D, Downey LL, Lim J, Cohen NL, Elowitz E. Uncommon lesions presenting as tumours of the internal auditory canal and cerebellopontine angle. Am J Otol 1997;18:386–92. 3. Moffat DA, Ballagh RH. Rare tumours of the cerebellopontine angle. Clin Oncol 1995;7:28–41. 4. Dey P, Mallik MK, Gupta SK, Vasishta RK. Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours and tumour like lesions. Cytopathology 2004;15: 32–7. 5. Preuss M, Stein M, Huegens-Penzel M, Kuchelmeister K, Nestler U. Metastatic tumours mimicking vestibular schwannoma. Acta Neurochir (Wien) 2008;150:915–9.
Utility of on-site cytological examination and cell block preparation in thyroid fine needle aspiration biopsy of metastatic carcinoma: report of two cases DOI:10.1111/cyt.12134
(c)
Figure 1. (a) Conventional preparation of cyst fluid showing loose clusters of cells with mild to moderate nuclear atypia (May–Gr€ unwald–Giemsa 91200). (b) Liquid-based cytology preparation of the cyst fluid showing a loose cluster of cells with enlarged pleomorphic nuclei (Papanicolaou 91200). (c) Histopathology section of the ancient schwannoma showing considerable nuclear enlargement and pleomorphism (haematoxylin and eosin 9440).
D. Gochhait, D. Chatterjee, A. Bal and P. Dey Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India References 1. Guevara N, Chays A, Bruzzo M et al. Cerebellopontine angle paraganglioma. Otol Neurotol 2003;24:469–72. Ó 2014 John Wiley & Sons Ltd Cytopathology 2015, 26, 50–60
Dear Editor, Fine needle aspiration biopsy (FNAB) of the thyroid is a reliable diagnostic tool for the diagnosis of primary and secondary neoplasms, whereas the identification of the origin of metastatic disease can sometimes be problematic.1 A good clinicopathological correlation before aspiration is important to prevent diagnostic difficulties. In this setting, on-site evaluation can be used in order to improve the adequacy of FNAB. In this way, preliminary information about the malignant potential of the lesion is provided and a decision is made to collect material for cell block histology.2 Here, we report two cases of metastatic lung adenocarcinoma to the thyroid that were reliably diagnosed by FNAB and immunocytochemistry applied on cell blocks. A 47-year-old man presented with a swelling in the right lobe of the thyroid. There was no significant history of any other diseases. Thyroid function tests were within normal limits. Ultrasound showed a 1.7-cm hypoechoic mass in the right lobe of the thyroid, and the remainder was unremarkable. The cellular smears comprised sheets and clusters of cells that were forming papillae or acini in a necrotic background. The cells had round, large, pleomorphic, irregularly
Correspondence: S. Guresci, MD, Sanatoryum Cad. Ardahan Sok. No 25, 06180 Kecioren, Ankara, Turkey Tel.: +90-312-356-90-00; Fax: +90-312-356-90-02; E-mail: [email protected]
57
Copyright of Cytopathology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Correspondence
has cytoplasmic vacuoles with displacement of the nuclei towards the periphery, but without an intracytoplasmic inclusion dense body.1 Therefore, careful observation can lead to the detection of the rhabdoid component in cytological examination. A. Kagotani1, M. Ishida1, K. Yoshida, M. Iwai and H. Okabe Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Shiga, Japan References 1. Perez-Montiel D, Wakely PE Jr, Hes O, Michal M, Suster S. High-grade urothelial carcinoma of the renal pelvis: clinicopathologic study of 108 cases with emphasis on unusual morphologic variants. Mod Pathol 2006;19: 494–503. 2. Parwani AV, Herawi M, Volmar K, Tsay SH, Epstein JI. Urothelial carcinoma with rhabdoid features: report of 6 cases. Hum Pathol 2006;37:168–72. 3. Fukumura Y, Fujii H, Mitani K et al. Urothelial carcinoma of the renal pelvis with rhabdoid features. Pathol Int 2009;59:322–5. 4. Duvdevani M, Nass D, Neumann Y et al. Pure rhabdoid tumor of the bladder. J Urol 2001;166:2337. 5. Inagaki T, Nagata M, Kaneko M et al. Carcinosarcoma with rhabdoid features of the urinary bladder in a 2year-old girl: possible histogenesis of stem cell origin. Pathol Int 2000;50:973–8. 6. Kumar S, Kumar D, Cowan DF. Transitional cell carcinoma with rhabdoid features. Am J Surg Pathol 1992;16:515–21. 7. Harris M, Eyden BP, Joglekar VM. Rhabdoid tumour of the bladder: a histological, ultrastructural and immunohistochemical study. Histopathology 1987;11:1083–92.
Cerebellopontine angle schwannoma masquerading as malignant tumour in cytology fluid of cyst DOI:10.1111/cyt.12123
Dear Editor, Cerebellopontine angle tumours comprise 5–10% of all intracranial tumours in adults. Of
Correspondence: Dr P. Dey, Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India Tel.: +91-172-2755120; Fax: +91-172-2744401; E-mail: [email protected]
these tumours, 80% are vestibular schwannomas. The other less common tumours of this region include meningioma, ependymoma, choroid plexus papilloma and epidermoid cyst.1–3 We present a case of ancient schwannoma in the cerebellopontine angle that was misdiagnosed as a malignant tumour on cytology of cyst fluid. The patient was a 62-year-old woman whose chief complaint was progressive left-sided hearing loss. Magnetic resonance imaging (MRI) showed a solid and cystic space-occupying lesion at the cerebellopontine angle, measuring approximately 1.5 cm in diameter. There was no enhancement of the tumour on MRI. Intraoperatively, the aspirated cyst fluid was sent for cytology. The conventional and liquidbased cytology (LBC, SurePathâ) smears showed pleomorphic cells in small clusters. Individual cells were round to oval with a moderate amount of vacuolated cytoplasm. The nuclei showed moderate pleomorphism with prominent nucleoli (Figure 1a, b). No mitotic activity was noted on the fluid smear. Considering the significant nuclear pleomorphism of the cells, the cyst fluid was reported as positive for malignancy, possibly a metastatic tumour. No frozen section was undertaken at the time of operation as the cyst was completely removed. On histopathological examination, the tumour was found to be a typical ancient schwannoma with large areas of Antoni B morphology and pleomorphic cells as a result of long-standing degenerative changes (Figure 1c). The mitotic count of the tumour was 1/50 high-power field. Schwannoma, and particularly ancient schwannoma, is notorious for cellular pleomorphism.4 In the present case, significant enlargement and pleomorphism of the nuclei were the sources of the mistake. Moreover, all the cells in the cytology smears were round to oval rather than elongated and spindle shaped in morphology. Considering the age of the patient and the nuclear pleomorphism, we wrongly labelled this case as metastatic tumour. Involvement of the cerebellopontine angle region by metastatic tumour is rare, usually arising from the lung, breast or gastrointestinal tract.5 Metastatic tumours in this region are usually bilateral at the time of presentation. In the present case, unilateral involvement and the history of loss of hearing were important clues to the diagnosis of schwannoma. In summary, ancient schwannoma is an important source of error and the cytopathologist should be careful in reporting cerebellopontine angle tumours. © 2013 John Wiley & Sons Ltd Cytopathology 2015, 26, 50–60
Correspondence
(a)
(b)
2. Kohan D, Downey LL, Lim J, Cohen NL, Elowitz E. Uncommon lesions presenting as tumours of the internal auditory canal and cerebellopontine angle. Am J Otol 1997;18:386–92. 3. Moffat DA, Ballagh RH. Rare tumours of the cerebellopontine angle. Clin Oncol 1995;7:28–41. 4. Dey P, Mallik MK, Gupta SK, Vasishta RK. Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours and tumour like lesions. Cytopathology 2004;15: 32–7. 5. Preuss M, Stein M, Huegens-Penzel M, Kuchelmeister K, Nestler U. Metastatic tumours mimicking vestibular schwannoma. Acta Neurochir (Wien) 2008;150:915–9.
Utility of on-site cytological examination and cell block preparation in thyroid fine needle aspiration biopsy of metastatic carcinoma: report of two cases DOI:10.1111/cyt.12134
(c)
Figure 1. (a) Conventional preparation of cyst fluid showing loose clusters of cells with mild to moderate nuclear atypia (May–Gr€ unwald–Giemsa 91200). (b) Liquid-based cytology preparation of the cyst fluid showing a loose cluster of cells with enlarged pleomorphic nuclei (Papanicolaou 91200). (c) Histopathology section of the ancient schwannoma showing considerable nuclear enlargement and pleomorphism (haematoxylin and eosin 9440).
D. Gochhait, D. Chatterjee, A. Bal and P. Dey Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India References 1. Guevara N, Chays A, Bruzzo M et al. Cerebellopontine angle paraganglioma. Otol Neurotol 2003;24:469–72. Ó 2014 John Wiley & Sons Ltd Cytopathology 2015, 26, 50–60
Dear Editor, Fine needle aspiration biopsy (FNAB) of the thyroid is a reliable diagnostic tool for the diagnosis of primary and secondary neoplasms, whereas the identification of the origin of metastatic disease can sometimes be problematic.1 A good clinicopathological correlation before aspiration is important to prevent diagnostic difficulties. In this setting, on-site evaluation can be used in order to improve the adequacy of FNAB. In this way, preliminary information about the malignant potential of the lesion is provided and a decision is made to collect material for cell block histology.2 Here, we report two cases of metastatic lung adenocarcinoma to the thyroid that were reliably diagnosed by FNAB and immunocytochemistry applied on cell blocks. A 47-year-old man presented with a swelling in the right lobe of the thyroid. There was no significant history of any other diseases. Thyroid function tests were within normal limits. Ultrasound showed a 1.7-cm hypoechoic mass in the right lobe of the thyroid, and the remainder was unremarkable. The cellular smears comprised sheets and clusters of cells that were forming papillae or acini in a necrotic background. The cells had round, large, pleomorphic, irregularly
Correspondence: S. Guresci, MD, Sanatoryum Cad. Ardahan Sok. No 25, 06180 Kecioren, Ankara, Turkey Tel.: +90-312-356-90-00; Fax: +90-312-356-90-02; E-mail: [email protected]
57
Correspondence
(a)
(b)
2. Kohan D, Downey LL, Lim J, Cohen NL, Elowitz E. Uncommon lesions presenting as tumours of the internal auditory canal and cerebellopontine angle. Am J Otol 1997;18:386–92. 3. Moffat DA, Ballagh RH. Rare tumours of the cerebellopontine angle. Clin Oncol 1995;7:28–41. 4. Dey P, Mallik MK, Gupta SK, Vasishta RK. Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours and tumour like lesions. Cytopathology 2004;15: 32–7. 5. Preuss M, Stein M, Huegens-Penzel M, Kuchelmeister K, Nestler U. Metastatic tumours mimicking vestibular schwannoma. Acta Neurochir (Wien) 2008;150:915–9.
Utility of on-site cytological examination and cell block preparation in thyroid fine needle aspiration biopsy of metastatic carcinoma: report of two cases DOI:10.1111/cyt.12134
(c)
Figure 1. (a) Conventional preparation of cyst fluid showing loose clusters of cells with mild to moderate nuclear atypia (May–Gr€ unwald–Giemsa 91200). (b) Liquid-based cytology preparation of the cyst fluid showing a loose cluster of cells with enlarged pleomorphic nuclei (Papanicolaou 91200). (c) Histopathology section of the ancient schwannoma showing considerable nuclear enlargement and pleomorphism (haematoxylin and eosin 9440).
D. Gochhait, D. Chatterjee, A. Bal and P. Dey Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India References 1. Guevara N, Chays A, Bruzzo M et al. Cerebellopontine angle paraganglioma. Otol Neurotol 2003;24:469–72. Ó 2014 John Wiley & Sons Ltd Cytopathology 2015, 26, 50–60
Dear Editor, Fine needle aspiration biopsy (FNAB) of the thyroid is a reliable diagnostic tool for the diagnosis of primary and secondary neoplasms, whereas the identification of the origin of metastatic disease can sometimes be problematic.1 A good clinicopathological correlation before aspiration is important to prevent diagnostic difficulties. In this setting, on-site evaluation can be used in order to improve the adequacy of FNAB. In this way, preliminary information about the malignant potential of the lesion is provided and a decision is made to collect material for cell block histology.2 Here, we report two cases of metastatic lung adenocarcinoma to the thyroid that were reliably diagnosed by FNAB and immunocytochemistry applied on cell blocks. A 47-year-old man presented with a swelling in the right lobe of the thyroid. There was no significant history of any other diseases. Thyroid function tests were within normal limits. Ultrasound showed a 1.7-cm hypoechoic mass in the right lobe of the thyroid, and the remainder was unremarkable. The cellular smears comprised sheets and clusters of cells that were forming papillae or acini in a necrotic background. The cells had round, large, pleomorphic, irregularly
Correspondence: S. Guresci, MD, Sanatoryum Cad. Ardahan Sok. No 25, 06180 Kecioren, Ankara, Turkey Tel.: +90-312-356-90-00; Fax: +90-312-356-90-02; E-mail: [email protected]
57
Copyright of Cytopathology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
