Abstract Introduction/Objective Glomus tumors are mesenchymal neoplasms with glomus body type modified smooth muscle cell differentiation. Most glomus tumors have a benign clinical course. However, rarely, they display malignant histologic features. Methods/Case Report We undertook a retrospective study using a natural language search in CoPath to find surgical pathology cases from 1993-2020 containing “glomus” in the pathology diagnosis. All relevant cases were included, and clinicopathologic data were reviewed in detail. Results (if a Case Study enter NA) A total of 66 tumors were identified, of which 42 were in female (63.6%) and 24 in male (36.4%) patients. The age at surgery ranged from 22 to 79 years with a median of 47.5. Females were significantly younger than males at presentation (p=0.025) by 8.8±3.8 years. Forty cases (60.6%) were located on the digits, 24 in nonvisceral soft tissue of extremities, trunk, and lip (36.4%), and one each in stomach and breast parenchyma. Sixty-three (95.5%) were benign (of which one recurred locally), 2 (3%) were malignant, and 1 (1.5%) was atypical. Four (6%) were multicentric. One case showed mixed histology (oncocytic and classic features) and one was classified as glomangiomatosis. The malignant cases each presented with a single tumor in lower extremity soft tissue in female patients (aged 33 and 49 years). The tumors measured 0.5 and 1.8 cm respectively and showed marked cytologic atypia in both and increased mitotic activity in the first. They were both completely excised. Conclusion The majority of glomus tumors are benign, however 3% are malignant. The most common location is the digits, followed by soft tissue. This tumor is more commonly seen in female patients. Unusual histologic variants such as glomangiomatosis and oncocytic component at times may create some difficulty to reach the diagnosis, especially on small biopsies. Unusual locations such as stomach can lead to a wrong diagnosis such as carcinoid, especially in a small biopsy material.

We present cytologic data from multiple samples from two cases of inverted sinonasal papilloma (ISP). These samples displayed the entire spectrum of squamous cell changes, including benign squamous papilloma, variable degrees of dysplasia, and invasive squamous cell carcinoma. In all instances, the cytologic impression coincided with the final diagnosis based on frozen and/or permanent histologic sections from the same samples. We suggest that cytologic examination be viewed as a useful initial approach in the diagnosis of ISP, and in the differential diagnosis of other tumors that occur in the same sites. Diagn. Cytopathol. 2004;30:201–207. © 2004 Wiley‐Liss, Inc.

Diagnostic CytopathologyVolume 30, Issue 1 p. 39-40 Images in Cytology Fine-needle aspiration of parotid gland schwannomas mimicking pleomorphic adenoma: A report of two cases L. Assad M.D., L. Assad M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorD. Treaba M.D., D. Treaba M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorR. Ariga M.D., R. Ariga M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorC. Bengana M.D., C. Bengana M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorS. Kapur M.D., S. Kapur M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorB. Bhattacharya M.D., B. Bhattacharya M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorV.B. Reddy M.D., V.B. Reddy M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorV.E. Gould M.D., V.E. Gould M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorP. Gattuso M.D., P. Gattuso M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorD. Yana M.D., D. Yana M.D. Department of Pathology Holy Family Hospital Des Plaines, IllinoisSearch for more papers by this author L. Assad M.D., L. Assad M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorD. Treaba M.D., D. Treaba M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorR. Ariga M.D., R. Ariga M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorC. Bengana M.D., C. Bengana M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorS. Kapur M.D., S. Kapur M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorB. Bhattacharya M.D., B. Bhattacharya M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorV.B. Reddy M.D., V.B. Reddy M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorV.E. Gould M.D., V.E. Gould M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorP. Gattuso M.D., P. Gattuso M.D. Department of Pathology Rush Presbyterian St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorD. Yana M.D., D. Yana M.D. Department of Pathology Holy Family Hospital Des Plaines, IllinoisSearch for more papers by this author First published: 22 December 2003 https://doi.org/10.1002/dc.10355Citations: 13AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume30, Issue1January 2004Pages 39-40 RelatedInformation

We report the fine-needle aspiration (FNA) cytology findings of Subcutaneous Panniculitis-like T-cell Lymphoma (SCPTCL) in a 66-year-old woman who presented with a four month history of asymptomatic subcutaneous nodules on her right chest wall and back. An excisional biopsy of the right chest nodules was performed, and the diagnosis of SCPTCL was rendered. On a follow-up visit, several skin lesions were noted throughout her body. A fine-needle aspiration (FNA) of the right inguinal region was performed. The FNA yielded cellular smears, composed mainly of sheets of epithelioid histiocytes and scattered multinucleated cells. However, no distinct granulomas were noted. The background of the cytological smears showed scattered atypical lymphoid cells, some of which displayed nuclear membrane irregularities. To the best of our knowledge, the cytological features on FNA material of SCPTCL have not been described.

HER-2/Neu overexpression is seen in 20% to 30% of invasive breast carcinomas and has been reported in as many as 80% of high-grade infiltrating carcinomas. Earlier studies have suggested that 100% of the tumor cells in mammary Paget disease show overexpression of HER-2 protein. We undertook this study to assess HER-2 status of mammary Paget disease and of the underlying breast carcinoma, when present, by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Formalin-fixed, paraffin-embedded tissue from 20 cases of mammary Paget disease were analyzed for HER-2 status by IHC and FISH. IHC for estrogen receptor (ER) was also performed. The patients ranged in age from 34 to 88 years, with a mean age of 62 years. Eighty percent of the cases showed strong overexpression (3+) of HER-2 protein by IHC, and all of these cases showed more than 5-fold amplification of the HER-2 gene by FISH. The remaining 4 cases, which were negative for HER-2/Neu by IHC, showed no amplification by FISH. All of the latter cases expressed ER, whereas no case that overexpressed HER-2 expressed ER. Sixteen cases had an underlying tumor, which was in situ in 6 cases. The underlying tumors were identical to the Paget disease with respect to their HER-2/Neu overexpression by both IHC and FISH. HER-2 overexpression was identified in 80% of our cases of Paget disease. There was 100% concordance between HER-2 protein overexpression by immunohistochemistry and gene amplification in both the Paget and the underlying tumor. Moreover, all of the cases negative for HER-2 overexpression expressed ER, whereas those positive for HER-2 did not.

This study addresses the utility of fine‐needle aspiration (FNA) in assessing lymphadenopathy in patients with and without a previous history of malignancy. We reviewed the FNAs of superficial and deeply seated lymph nodes performed at our institution over a period of 18 yr (1983–2001). Where applicable, we also reviewed and report here the results of subsequent surgical excisional biopsies. We analyzed data from 439 patients, who ranged in age from 1 to 90 yr. The neck and retroperitoneum were the most frequently sampled sites (47% and 25%, respectively). Among the 439 FNAs, adequate material was obtained in 421 cases (96%); the remaining 18 were unsatisfactory (4.1%). Malignant diagnoses were rendered in 330 cases (75% of 439), four were suspicious for lymphoma (0.9%), and 87 were read as reactive lymph nodes or granulomas (20%). The most common malignant cytologic diagnoses from these lymph node FNAs were adenocarcinoma, squamous cell carcinoma, and lymphoma. We compared results between two major groups: patients with a history of malignancy and those without. FNA showed malignancy in 87% of patients with a history of cancer and 41% without such a history. Thirty‐three or 10% of patients with a history of malignancy were given a benign diagnosis and follow‐up surgical excisional biopsies were performed in nine of these cases. Four of the nine showed low‐grade lymphoma. Of the 18 nondiagnostic FNAs, nine came from patients with a history of malignancy and in six of these nine who had a follow‐up surgical excisional biopsy the lymph nodes were positive for malignancy. Of the other nine, who had no history of malignancy, only two had follow‐up biopsies and both of these were negative. Patients with a history of malignancy are more than twice as likely to show malignancy on lymph node FNA compared to those without such a history (87% vs. 41%). Knowing whether a patient has a history of malignancy provides the appropriate level of suspicion for ordering ancillary investigations or even recommending excisional biopsy for further evaluation. Diagn. Cytopathol. 2003;29:315–319. © 2003 Wiley‐Liss, Inc.

At the present time fine-needle aspiration (FNA) is considered a routine diagnostic procedure in evaluating neoplastic vs. nonneoplastic lesions in many organs, with high sensitivity and specificity. The purpose of this study was to assess the utility of FNA in areas of diagnostic difficulty and its limitations in evaluating bone lesions in patients with a previous history of malignancy. From 1989 to 2000, 249 CT-guided FNAs of bone lesion were performed at our institutions; 187/249 (75.1%) patients had a previous history of malignancy. Aspirated material was air-dried for Diff-Quik stain or fixed in ethanol for Papanicolaou staining. Subsequent surgical tissue was available in 69/187 (36.9%) of the cases. There were 114 males and 73 females, ages 14-86 yr (mean, 64 yr). The primary tumor site was lung 49, genitourinary 46, breast 31, gastrointestinal 28, hematopoietic 26, soft tissue/skin 5, and thyroid 2. There were 125 FNAs of the vertebral spine, 19 from the pelvis, 11 from the ribs, 9 from the sternum, 5 from the femur, and 18 from miscellaneous bone sites. Out of 187, 166 (88.7%) were malignant aspirates confirming the patients' primary malignancies. The most common malignancy encountered was adenocarcinoma, 126/187 (67.4%). Surgical tissue was available for review in 69 patients and the results were in agreement with the FNAs diagnosis in all cases. Nine out of 187 (4.8%) cases were diagnosed as marrow elements on cytological material. These patients have been followed for 1-9 yr and have failed to reveal signs or symptoms of clinical recurrence. Three out of 187 (1.6%) cases showed osteomyelitis. Nine out of 187 (4.8%) were unsatisfactory specimens, with biopsy follow-up available in four cases, showing three metastatic tumors and one case of osteomyelitis. FNA of metastatic bone lesions is a major step in pretreatment diagnosis. On satisfactory specimens, the cytological diagnosis viewed in the clinical-radiological context proves to be similar to surgical diagnosis. FNA is an excellent technique with a high accuracy rate in assessing metastatic bone lesions.

BACKGROUND:The purpose of this study was to compare the diagnostic accuracy of fine-needle aspiration (FNA) of clinically suspicious palpable breast masses in women younger and older than 40 years of age.METHODS:All women who had FNA biopsy with subsequent tissue biopsy were included. The cytologic diagnoses were classified into three groups: malignant, suspicious, or benign. Histopathologic correlation was based on either a needle core biopsy, an excisional biopsy, or a mastectomy specimen.RESULTS:A total of 1,158 fine-needle aspirations performed between 1982 and 2000, on women being evaluated for a clinically palpable breast mass were included in the study. The patients were divided into two groups: group I consisted of 231 patients aged 40 years and younger, and group II consisted of 927 patients aged 41 years and older. In group I there were 117 (51%) malignant FNA diagnoses, and only 1 (1%) false-positive case, subsequently diagnosed on histopathologic material as an atypical papillomatosis. There were 20 (9%) cases diagnosed as suspicious on FNA. On histopathology 10 were malignant, and 10 were benign. Of the 91 (39%) cases interpreted as benign, only 1 (1%) was a false negative. In group II, which comprised 927 patients, there were 693 (74%) malignant FNA diagnoses, and 3 (less than 1%) false-positive cases, which on follow-up histopathologic examination revealed 2 atypical ductal hyperplasias and 1 atypical papilloma. There were 90 (10%) cases diagnosed as suspicious on FNA. On histopathology, 68 were malignant and 22 were benign. Of the 131 (14%) lesions interpreted as benign, there were 18 false-negative cases (14%), which included 17 infiltrating carcinomas and 1 ductal carcinoma in-situ. Twelve (1%) of the cases were inadequate for the study.CONCLUSIONS:The sensitivity, specificity, and positive predictive values were remarkably high and comparable in both groups: group I had 99% sensitivity, 99% positive predictive value, 99% specificity, and 99% negative predictive value; and group II had 98% sensitivity, 97% specificity, 99% positive predictive value, and 86% negative predictive value. The overall rate of false-positive (less than 1%) and false-negative cases (9%) is comparable with published literature. Suspicious cases should be further evaluated, as our study revealed more than 50% to be malignant. The incidence of malignancy in patients presenting with a clinically palpable breast mass with follow-up biopsy was 51% in patients aged 40 years and younger and 74% in patients aged 41 years and older. Fine-needle aspiration is an excellent diagnostic tool in assessing clinically palpable breast masses.

A 4(1/2)-yr-old female presented with right-sided pleural effusion and a retroperitoneal mass. Cytologic analysis of the pleural fluid yielded malignant small round blue cells, which were noncohesive, 3-4 times the size of lymphocytes. The malignant cells had hyperchromatic, pleomorphic nuclei with moderate amounts of vacuolated cytoplasm. A few fiber-shaped cells were also seen. Immunostains for desmin, muscle-specific actin were positive; ultrastructural findings of thick and thin actin-myosin filaments confirmed the diagnosis of embryonal rhabdomyosarcoma. This case illustrates the importance of performing appropriate immunohistochemical stains and ultrastructural studies on cytological material to arrive at a definitive diagnosis.

In the last two decades posttransplant lymphoproliferative disorders (PTLDs) have been recognized as a complication of organ transplantation with immunosuppression. The reported incidence of PTLDs in renal transplant patients ranges between 0.3–3% (Birkeland et al., Transplantation 1999;67:876–881). In contrast to the reported incidence of PTLDs in post bone marrow transplant, it is 1% in HLA‐matched recipients and up to 20% in HLA mismatched T‐cell depleted bone marrow recipients (Curtis et al., Blood 1996;94:2208–2216). 2 In cardiac transplant recipients the reported incidence of PTLDs is between 1.8–9.8 (Mihalov et al., Clin Transplant 1996;10:248–255). PTLDs are predominately extranodal. They have varied morphologic patterns and clonality, but almost all are associated with Epstein‐Barr virus (EBV). The vast majority are of B cell lineage; only about 10% are of T‐cell origin. We report a T‐cell anaplastic large cell lymphoma (ALCL) presenting with bilateral pleural effusion and liver involvement in a renal transplant recipient. Diagn. Cytopathol. 2002;27:35–37. © 2002 Wiley‐Liss, Inc.

There is relatively little information concerning the use of fine-needle aspiration (FNA) to diagnose extranodal and extramedullary hematopoietic malignancies. Seventy-one such cases diagnosed by FNA form the basis of this study. Seventy-one cases of FNAs performed between 1988 and 1998 on extranodal and extramedullary hematopoietic malignancies were reviewed in order to evaluate the usefulness of this technique in diagnosing these entities as well as to assess patterns of relapse. There were 45 male and 26 female patients ranging in age from 29-86 years (mean, 68 years). Sixty-six patients had a previous history of a hematopoietic malignancy. Aspirates from 65 of these patients were consistent with the patient's known primary. One aspirate of a paravertebral mass from a multiple myeloma patient showed extramedullary hematopoiesis. The remaining five aspirates were cases of multiple myeloma that first presented as soft tissue masses. The most common malignancies were lymphoma: 52 cases (73%), 48 large cell lymphomas, four mixed small and large cell lymphoma; followed by multiple myeloma: 12 cases (17%); leukemia: four cases (5.4%); Hodgkin disease: two cases (2.8%); and one case of extramedullary hematopoiesis. The aspirate sites were soft tissue: 23 cases (32%); bone: 17 cases (24%); kidney: 14 cases (20%); liver: 11 cases (15%); lung: three cases (4%); adrenal: two cases (3%); and eye: one case. The interval between primary diagnosis and FNA was 1-36 months (mean, 13 months). In conclusion, 98% of the aspirates were neoplastic in patients with a known history of hematopoietic malignancies. The most common site of involvement was soft tissue in 23 (32%) cases. In five patients with multiple myeloma, the FNA diagnosis prompted a work-up to find the primary site of involvement. FNA is a useful technique in assessing extranodal and extramedullary hematopoietic malignancies.

With improved radiologic techniques fine-needle aspiration (FNA) is becoming a rapid, effective diagnostic method in evaluating a wide range of liver masses. Review of six hundred two radiologically guided liver aspirates performed over a ten-year period forms the basis of this report.

Renal masses secondary to metastases are not common. Few comprehensive reviews exist, which consist primarily of autopsy and radiologic reports. The purpose of this study was to review the types and incidences of various neoplasms which metastasize to the kidney and to determine the usefulness of fine-needle aspiration (FNA) in diagnosing them. Two hundred and sixty-one radiologically guided FNAs of renal lesions over a 9-yr period were reviewed. The diagnoses of the 261 renal FNAs were as follows: 136 (52%) were malignant, 111 (43%) were benign, and 14 (5%) were unsatisfactory. Of the 136 positive FNAs, 28 (21%) revealed metastatic tumors. The overall incidence of renal FNAs displaying metastatic tumors was 11%. Among the 28 patients with metastases to the kidney, 23 patients were men and 5 were women, with the mean age being 58 yr. Twenty-five patients (89%) had prior history of a primary malignancy, including lung carcinoma (11 cases, 39%), lymphoma (8 cases, 29%), hepatocellular carcinoma (3 cases, 11%), and one case each of breast, pancreatic, and cervical cancer. In the remaining 3 patients (11%), with metastatic adenocarcinoma (2 cases) and squamous-cell carcinoma (1 case), the primary tumor site remained unknown despite an extensive clinical workup. Overall survival after FNA was poor, with a mean of 9.8 mo. FNA is useful in the diagnosis of masses in the kidney secondary to metastatic disease. This information is of clinical importance, principally in the exclusion of a primary malignancy, but also to avoid unnecessary surgery and to plan for subsequent patient care.

Diagnostic CytopathologyVolume 20, Issue 5 p. 323-324 Letter to the Editor Fine-needle aspiration of pseudoangiomatous stromal hyperplasia of the breast Daniel J. Spitz M.D., Daniel J. Spitz M.D. Department of Pathology Rush-Presbyterian–St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorVijaya B. Reddy M.D., Vijaya B. Reddy M.D. Department of Pathology Rush-Presbyterian–St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorPaolo Gattuso M.D., Corresponding Author Paolo Gattuso M.D. Department of Pathology Rush-Presbyterian–St. Luke's Medical Center Chicago, IllinoisDepartment of Pathology, Rush-Presbyterian–St. Luke's Medical Center, 1653 West Congress Parkway, Jelke 582, Chicago, IL 60612.Search for more papers by this author Daniel J. Spitz M.D., Daniel J. Spitz M.D. Department of Pathology Rush-Presbyterian–St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorVijaya B. Reddy M.D., Vijaya B. Reddy M.D. Department of Pathology Rush-Presbyterian–St. Luke's Medical Center Chicago, IllinoisSearch for more papers by this authorPaolo Gattuso M.D., Corresponding Author Paolo Gattuso M.D. Department of Pathology Rush-Presbyterian–St. Luke's Medical Center Chicago, IllinoisDepartment of Pathology, Rush-Presbyterian–St. Luke's Medical Center, 1653 West Congress Parkway, Jelke 582, Chicago, IL 60612.Search for more papers by this author First published: 26 April 1999 https://doi.org/10.1002/(SICI)1097-0339(199905)20:5<323::AID-DC16>3.0.CO;2-DCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume20, Issue5May 1999Pages 323-324 RelatedInformation

Fine-needle aspiration biopsy (FNAB) has been used with high sensitivity and specificity in the diagnosis of both Hodgkin's and non-Hodgkin's lymphoma. However, studies of FNAB of posttransplant lymphoproliferative disorders (PTLDs) are rare. The clinical course of 593 allograft recipients (cardiac, 288; renal, 250; lung, 50; and heart/lung, 5) was reviewed. Twenty-six patients developed PTLD with an overall incidence of 4.4%. Of these patients, 12 underwent FNAB. Their age ranged from 33-67 yr (mean, 55 yr). The interval between transplantation and FNAB ranged between 2-14 mo (average, 8.4 mo). The lungs were the most common site aspirated (7 cases), followed by lymph nodes (3 cases) and other extranodal sites (2 cases, liver and paraspinal mass). The cytologic features of these aspirates could be classified into two categories: a polymorphous smear composed of a spectrum of mature and immature lymphocytes with scattered plasma cells and histiocytes; and a monotonous population of large lymphoid cells consistent with malignant lymphoma, large-cell type. Surgical biopsies were available in 10 (83.3%) cases and confirmed the FNAB diagnosis. In summary, FNAB appears to be a highly sensitive and specific diagnostic tool in patients with PTLD. (C) 1997 Wiley-Liss, Inc.