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Items 1-34 of 34 |
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Rhabdomyosarcoma. Cytomorphology, subtyping and differential diagnostic dilemmas.
Pohar-Marinsek Z, Bracko M.
Department of Cytopathology, Institute of Oncology, Ljubljana, Slovenia.
OBJECTIVE: To identify morphologic characteristics and architectural patterns of rhabdomyosarcoma (RMS), to attempt a subclassification from fine needle aspiration biopsy (FNAB) smears and to point out some differential diagnostic problems. STUDY DESIGN: We reviewed all positive cytologic material from 53 patients with RMS whose diagnoses were histologically and/or immunocytochemically confirmed. We analyzed several morphologic features and identified architectural patterns of smears. RESULTS: Among alveolar RMS, we identified two major architectural patterns: one containing completely dissociated cells and one containing many chance formations. Among the embryonal type, the predominant architectural pattern contained large tissue fragments with abundant eosinophilic material and various numbers of dissociated cells. The pattern of only dissociated cells was similar to the one seen in the alveolar type. The relative proportion of poorly to better and well-differentiated rhabdomyoblasts varied in both types and in all patterns. CONCLUSION: RMS exhibits a variety of morphologic pictures regarding cellular morphology and architectural patterns, even within the same histologic subtype. Therefore, a reliable subclassification into alveolar and embryonal RMS cannot be made from FNAB smears. The embryonal type can be suggested in cases containing large tissue fragments with abundant eosinophilic material and small, tightly packed cells with oval nuclei. However, all cases suspected to be RMS must always be confirmed immunocytochemically since they could be confused with some benign and malignant tumors with similar morphology.
PMID: 10934943 [PubMed - indexed for MEDLINE]
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Fine needle aspiration biopsy of a small round cell tumor exhibiting both neural and myogenic differentiation. A case report.
Ravinsky E, Safneck JR, Quinonez G, Yazdi HM.
Department of Pathology, University of Manitoba, Winnipeg, Canada.
BACKGROUND: Divergent differentiation may not be detected in the limited material available in a fine needle aspiration biopsy (FNAB). CASE: A small round cell malignancy showed neural features ultrastructurally on FNAB, in keeping with primitive neuroectodermal tumor, but desmin and actin positivity on surgical biopsy, suggesting rhabdomyosarcoma. CONCLUSION: Accurate classification of small round cell tumors by FNAB is more likely to occur when both electron microscopy and immunocytochemistry are employed since these tumors may express divergent differentiation.
PMID: 9990266 [PubMed - indexed for MEDLINE]
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Adult embryonal rhabdomyosarcoma metastatic to the breast and diagnosed by fine needle aspiration. A case report.
Lai CR, Hsu CY, Tsay SH, Hung-Chiang.
Department of Pathology, Veterans General Hospital-Taipei, Taiwan, Republic of China.
BACKGROUND: Metastasis to the breast from extra-mammary malignancies is rare, but its recognition is important. A solitary metastasis must be distinguished from the primary breast cancer because the treatment and prognosis are quite different. CASE: A 30-year-old female presented with a 4.0-cm, solitary, nontender mass in the upper outer quadrant of the right breast 11 months after primary surgery for maxillary sinus embryonal rhabdomyosarcoma. The cytomorphology revealed features of small round cell tumor. Immunocytochemical staining disclosed a positive reaction to vimentin and desmin and negative reaction to cytokeratin, confirming the diagnosis of rhabdomyosarcoma. CONCLUSION: Fine needle aspiration with ancillary studies is essential in the diagnosis of metastatic malignancy of the breast in order to avoid unnecessary mastectomy and to implement appropriate systemic therapy.
PMID: 9167712 [PubMed - indexed for MEDLINE]
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Fine needle aspiration of poorly differentiated rhabdomyosarcoma presenting with quadriparesis. A case report.
Agarwal PK, Srivastava A, Mathur N, Pant MC, Agarwal S.
Department of Pathology, King George's Medical College, Lucknow, India.
BACKGROUND: The diagnosis of metastatic poorly differentiated rhabdomyosarcoma (RMS) in lymph node specimens by fine needle aspiration presents a difficult problem since it is virtually indistinguishable from other small round cell neoplasms. CASE: Fine needle aspiration was performed under radiologic guidance on an extradural, space-occupying lesion of unknown etiology in the region of the C-6 and C-7 vertebrae in a 20-year-old male who was hospitalized with quadriparesis. Cytologic examination suggested a metastatic tumor consistent with the diagnosis of rhabdomyosarcoma. A subsequent search for the primary tumor site revealed a soft tissue swelling in the right calf muscle. Light microscopic, ultrastructural and immunocytochemical examination of multiple Tru-cut biopsy specimens from the swelling in the right calf muscle confirmed the diagnosis of poorly differentiated embryonal rhabdomyosarcoma. CONCLUSION: Immunostaining is useful for muscle proteins in the detection of poorly differentiated forms of embryonal rhabdomyosarcoma. Electron microscopy is of limited use in such cases.
PMID: 8842179 [PubMed - indexed for MEDLINE]
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Fine needle aspiration of prostatic rhabdomyosarcoma. A case report demonstrating the value of DNA ploidy.
Moroz K, Crespo P, de las Morenas A.
Mallory Institute of Pathology, Boston University School of Medicine, Massachusetts 02118, USA.
A case of primary rhabdomyosarcoma of the prostate diagnosed by fine needle aspiration biopsy and confirmed with immunocytochemistry is described. Evaluation of DNA content of tumor cell nuclei by image analysis was performed to complement the diagnosis and clinical stage information and to further predict the tumor response to chemotherapy. Diploid tumors should prompt clinicians to use a more aggressive chemotherapeutic protocol to achieve as favorable a response to therapy as that seen in aneuploid tumors. The DNA content obtained with differently fixed and stained specimens yielded similar results, further confirming the wide applicability of image analysis as a diagnostic/prognostic tool in prospective and retrospective studies in pathology.
PMID: 7543238 [PubMed - indexed for MEDLINE]
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Pleomorphic rhabdomyosarcoma of the heart metastatic to bone. Report of a case with fine needle aspiration biopsy findings.
Ali SZ, Smilari TF, Teichberg S, Hajdu SI.
Department of Laboratories, North Shore University Hospital-Cornell University Medical College, Manhasset, New York 11030, USA.
Pleomorphic rhabdomyosarcoma is an extremely rare and highly malignant neoplasm. We report an unusual case of a 14-year-old boy with skeletal metastases from a primary cardiac tumor. Fine needle aspiration biopsy of a lytic lesion in the right iliac wing showed a pleomorphic population of clusters and single cells with hyperchromatic nuclei; granular, pink cytoplasm; and isolated, large cells with whiplike or globoid cytoplasmic processes and occasional striations. Histologic, ultrastructural and radiologic features are also presented.
PMID: 7762352 [PubMed - indexed for MEDLINE]
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Meningeal rhabdomyosarcoma. Report of a case with cytologic, immunohistologic and ultrastructural studies.
Kobayashi S, Hirakawa E, Sasaki M, Ishikawa M, Haba R.
First Department of Pathology, Kagawa Medical School, Japan.
Primary rhabdomyosarcoma of the meninges, a very rare brain tumor, is reported. Cytologic findings by squash preparation were useful as an adjunct to frozen section diagnosis during surgery. The cytologic features of rhabdomyosarcoma without cross-striation have some similarities to those of gemistocytic astrocytomas and anaplastic meningiomas, but the cytoplasmic filaments of rhabdomyosarcoma are different from those of gemistocytic astrocytoma and anaplastic meningioma. Histologically the tumor was embryonal rhabdomyosarcoma with a partially botryoid pattern. The tumor cells have no cross-striations but react positively to antimyoglobin serum on immunoperoxidase staining. In this case, intracytoplasmic filaments resembling poorly formed myofibrils were found on electron microscopic study. The histologic and immunohistologic findings suggest that this rare mesenchymal malignancy might arise from primitive totipotential cells.
PMID: 7762328 [PubMed - indexed for MEDLINE]
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Cytologic diagnosis of rhabdomyosarcoma in a patient with germ cell tumor. A case report.
Kaw YT, Cramer HM.
Department of Pathology, Indiana University Medical Center, Indianapolis.
The development of sarcomas in patients with germ cell tumors is rare but has been reported previously. Theories about its pathogenesis include derivation of the tumor cells from pluripotential germ cells and malignant transformation from teratomatous elements. This report describes the occurrence of rhabdomyosarcoma in a patient with a history of mixed germ cell tumor of the testis who developed a malignant pleural effusion. Cytologic evaluation of the fluid revealed single malignant cells with high nuclear/cytoplasmic ratios and prominent nucleoli. While these features initially suggested a diagnosis of metastatic seminoma, careful cytologic and immunohistochemical examination revealed features consistent with metastatic rhabdomyosarcoma. The exfoliative cytologic findings of other germ cell tumors are also discussed.
PMID: 7887073 [PubMed - indexed for MEDLINE]
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Testicular embryonal rhabdomyosarcoma diagnosed by fine needle aspiration cytology. A report of two cases.
Kumar PV, Kazemi H, Khezri A.
Department of Pathology, Medical School, Shiraz University of Medical Sciences, Iran.
During a 12-year period, 1980-1992, two cases of testicular embryonal rhabdomyosarcoma were diagnosed by fine needle aspiration cytology at the Shiraz University Hospitals. The smears revealed various types of cells including spindle cells, strap cells, rhabdomyoblasts, round cells and tadpole cells with a high nuclear/cytoplasmic ratio. Cross-striations were noticed in the cytoplasm at higher magnification under oil immersion. The cytologic diagnoses of embryonal rhabdomyosarcomas were confirmed on histologic sections.
PMID: 8042425 [PubMed - indexed for MEDLINE]
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Fine needle aspiration biopsy of pediatric orbital tumors. An immunocytochemical study.
Arora R, Betharia SM.
Department of Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, Delhi, India.
Specific antibodies against neuron-specific enolase, leukocyte common antigen and desmin were assessed for their usefulness in the cytodiagnosis of 23 cases of pediatric orbital round cell tumors (10 cases of orbital recurrence of retinoblastoma, 11 cases of embryonal rhabdomyosarcoma and 2 cases of inflammatory pseudotumor). Alcohol-fixed, Papanicolaou-stained smears were decolorized and stained with monoclonal antisera using the peroxidase-antiperoxidase procedure. Twenty of 23 aspirates were positively immunostained with antisera against leukocyte common antigen, desmin and neuron-specific enolase. Eight of 10 cases of clinically diagnosed orbital recurrence of retinoblastoma showed strong monotypic staining with anti-neuron-specific enolase antiserum. More than 50% of tumor cells in 9/11 cases of embryonal rhabdomyosarcoma were also immunopositive with this antiserum. Desmin positivity was seen in 10/11 cases of embryonal rhabdomyosarcoma, whereas immunopositivity with leukocyte common antigen was detected in both cases of inflammatory pseudotumor. These results indicate that the use of a panel of monoclonal antibodies on aspirate smears is imperative for establishing the diagnosis and classification of pediatric round cell orbital tumors.
PMID: 8042414 [PubMed - indexed for MEDLINE]
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Fine needle aspiration biopsy in pediatric ophthalmic tumors and pseudotumors.
O'Hara BJ, Ehya H, Shields JA, Augsburger JJ, Shields CL, Eagle RC Jr.
Department of Pathology and Cell Biology, Jefferson Medical College, Philadelphia, Pennsylvania.
In an eight-year period (1983-1990) approximately 500 fine needle aspiration biopsies (FNABs) of eye lesions were processed in our laboratory. Eighty-one of the cases, obtained from 77 pediatric patients (ranging from 4 weeks to 16 years of age), were the subject of this study. The specimens included 73 intraocular and 8 orbital aspirates. Forty-four of the specimens were from diagnostic procedures, whereas 37 were obtained from surgical specimens immediately after enucleation. Eight FNABs (four diagnostic and four postenucleation) were deemed inadequate for cytologic diagnosis. Of the remaining 73 cases, 38 were diagnosed as malignant (34 retinoblastomas, 3 medulloepitheliomas, 1 rhabdomyosarcoma), and all were confirmed upon subsequent histologic examination. Four cases were diagnosed as suspicious for malignancy; all of them proved to be malignant (two retinoblastomas, two rhabdomyosarcomas). One orbital aspirate contained cells suggestive of a glial origin and was confirmed histologically as pilocytic astrocytoma. Ten cases were reported as compatible with Coats' disease; all were confirmed to be benign by histologic examination (three cases) or clinical follow-up (seven cases). The remaining 20 benign aspirates (13 with inflammatory cells, 6 with macrophages and 1 with blood) proved to be from benign conditions by histologic examination (4 cases) or clinical follow-up (16 cases). There were no false-positive diagnoses. The overall accuracy of FNAB was 95%, and the accuracy of cytologic interpretation was 100%. We conclude that FNAB is a reliable and accurate diagnostic modality in the assessment of selected pediatric ophthalmic diseases.
PMID: 8465629 [PubMed - indexed for MEDLINE]
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Fine needle aspiration biopsy diagnosis of rhabdomyosarcoma. An immunocytochemical study.
de Jong AS, van Kessel-van Vark M, van Heerde P.
Department of Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoekhuis, Amsterdam.
Specific antibodies against desmin, skeletal muscle actin and myosin were assessed for their usefulness in the cytodiagnosis of five rhabdomyosarcomas: one well-differentiated, two moderately differentiated and two poorly differentiated lesions. Acetone-fixed smears from fine needle aspiration biopsies and the avidin-biotinyl-peroxidase complex technique were used. All aspirates were positively immunostained with antibodies against desmin and actin. Myosin could only be detected in the moderately and well-differentiated tumors. The percentage of tumor cells positive for any of the three proteins was positively correlated with the overall degree of differentiation. However, the number of positive tumor cells decreased in the sequence desmin-actin-myosin. The results indicate the value of antibodies, especially those against skeletal muscle actin, in aiding in the cytodiagnosis of rhabdomyosarcoma, particularly with respect to its differential diagnosis from small round cell tumors in children and pleomorphic sarcomas in adults.
PMID: 3314303 [PubMed - indexed for MEDLINE]
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Cytology of fine needle aspiration biopsy of primary breast rhabdomyosarcoma in an adolescent girl.
Torres V, Ferrer R.
A bilateral breast tumor in an 11-year-old girl was diagnosed as a malignant mesenchymal neoplasm by fine needle aspiration biopsy, and its muscular origin was suggested. An immunoperoxidase stain for the demonstration of intracellular myoglobin in destained cytologic aspirates exhibited a positive reaction of variable intensity in some of the undifferentiated round cells and in the more mature bipolar sarcomatous elements. These findings were confirmed in the histologic sections of the excised tissue. Needle aspiration is helpful in these rare cases of primary breast rhabdomyosarcoma, which often present with a solid, undifferentiated histologic pattern in this age group. In addition to the cytologic characteristics, the possibility of detecting muscle antigens as markers for these embryonal small cells, even in previously stained slides, provides a successful method for defining the specific type of sarcoma.
PMID: 3859144 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration biopsy of alveolar rhabdomyosarcoma of the parotid: a case report and review of the literature.
Valencerina Gopez E, Dauterman J, Layfield LJ.
Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah. [email protected]
The cytologic features of an alveolar rhabdomyosarcoma arising within the parotid gland are described. The occurrence of this neoplasm as a primary malignancy in the parotid gland is very rare, and the tumor is usually not included in the cytologic differential diagnosis of parotid tumors. The diagnosis of the current case was achieved by a combination of fine-needle aspiration biopsy and frozen sections. Realizing the difficulty of recognizing this tumor both histologically and cytologically, we present this case to increase the awareness of this tumor's occurrence within the parotid gland and other salivary glands, and to highlight cytomorphologic features that will aid the pathologist in making the correct diagnosis. Copyright 2001 Wiley-Liss, Inc.
Publication Types:
- Review
- Review of reported cases
PMID: 11285621 [PubMed - indexed for MEDLINE]
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Role of immunocytochemistry and DNA flow cytometry in the fine-needle aspiration diagnosis of malignant small round-cell tumors.
Brahmi U, Rajwanshi A, Joshi K, Ganguly NK, Vohra H, Gupta SK, Dey P.
Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
In the present study, DNA flow cytometry (FCM) and immunocytochemistry (ICC) with a selected panel of antibodies were performed on 51 cases of malignant tumors which were referred for fine-needle aspiration biopsy (FNAB) to our Department of Cytology for the last 2 yr. Twelve cases were diagnosed as neuroblastoma, 16 as Ewing's sarcoma, 2 as retinoblastoma, 5 as non-Hodgkin's lymphoma (NHL), 5 as rhabdomyosarcoma, 2 as peripheral neuroectodermal tumors (PNETs), and 8 as Wilms' tumor. Eleven of 12 neuroblastomas were diploid by FCM, and 1 was aneuploid, with an S-phase fraction (SPF) of 8.3%. Neuron-specific enolase (NSE) was negative in 3 and positive in 8 cases of neuroblastoma, whereas neuroblastoma marker was positive in 3/11. Sixteen of 17 Ewing's sarcomas were diploid, and 1 showed tetraploid aneuploidy, with an SPF of 10.06%. Eight of 13 Ewing's sarcomas were positive for Mic-2 gene product (Ewing's marker). All 5 NHL were positive for leukocyte-common antigen (LCA). Three of 5 rhabdomyosarcomas were diploid, and 2 cases showed aneuploidy. Rhabdomyosarcoma showed muscle-specific actin positivity in 4 and desmin positivity in 3 cases. All 3 cases of PNET were diploid and positive for the Mic-2 gene product, whereas NSE and vimentin were positive in 2 cases. Both cases of retinoblastoma were diploid. Immunostaining was noncontributory in 1 case, and the other showed positivity for the retinoblastoma gene product, NSE, and chromogranin. Seven of 8 Wilms' tumors were diploid, and 1 showed aneuploid, with an SPF of 11.13%. Seven of 8 Wilms' tumors were positive for cytokeratin (CK), 5 were positive for NSE, 6 were positive for epithelial membrane antigen (EMA), and 5 were positive for vimentin. FNAB diagnosis of malignant round-cell tumors is difficult only by light microscopy. Due to the availability of specific markers for subgrouping tumors, ICC has proved to be more useful these days, while DNA FCM has little diagnostic value, as most of them are diploid. Further ancillary studies, e.g., electron microscopy, image analysis, and other molecular investigations, are required to further categorize these tumors more precisely for better clinical management of these cases. Copyright 2001 Wiley-Liss, Inc.
PMID: 11285617 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration biopsy of metastatic soft-tissue sarcomas to lymph nodes.
Khirwadkar N, Dey P, Das A, Gupta SK.
Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
This paper highlights the role of fine-needle aspiration cytology (FNAC) in 15 cases of metastatic soft-tissue sarcomas involving lymph nodes. Histopathology reports of the primary tumor were available in all cases. Histological diagnoses correlated well with the cytology reports. The most common type of sarcoma to involve the lymph node was embryonal rhabdomyosarcoma (6 cases), followed by synovial sarcoma (2 cases), leiomyosarcoma (2 cases), malignant fibrous histiocytoma (2 cases), fibrosarcoma (1 case), malignant peripheral nerve sheath tumor (1 case), and rhabdomyosarcoma (1 case). FNAC was thus helpful in the early diagnosis, proper staging, and management. Importantly, it obviated a lymph node biopsy in the majority of cases. Copyright 2001 Wiley-Liss, Inc.
PMID: 11285616 [PubMed - indexed for MEDLINE]
Rhabdomyosarcoma in a child with massive pleural effusion: cytological diagnosis from pleural fluid.
Cohen I, Loberant N, King E, Herskovits M, Sweed Y, Jerushalmi J.
Department of Pathology, Western Galilee Hospital, Nahariya, Israel.
We report on a case of embryonal rhabdomyosarcoma in an 11-yr-old boy investigated for mild chest pain after trauma. Chest radiography showed a massive right pleural effusion. Cytological analysis of the pleural fluid demonstrated the presence of malignant small undifferentiated cells. The rhabdomyoblastic nature of the cells was confirmed by positive immunostains of HHf35 actin, desmin, and skeletal muscle myosin; histological examination of a core biopsy confirmed the diagnosis of rhabdomyosarcoma. Computed tomography and gallium scan revealed the presence of an extensive anterior and lower chest wall mass involving the mediastinum, as well as retroperitoneal lymphadenopathy. Massive pleural effusion is a frequent presentation in malignant disease, but is rare in rhabdomyosarcoma. The immunochemical stain studies performed on cytological smears in this case proved to be very useful for making the definitive and accurate diagnosis. Diagn. Cytopathol. 1999;21:125-128. Copyright 1999 Wiley-Liss, Inc.
PMID: 10425051 [PubMed - indexed for MEDLINE]
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Logistic regression analysis of small round cell neoplasms: a cytologic study.
Layfield LJ, Liu K, Dodge RK.
Department of Pathology, University of Utah Health Sciences Center, Salt Lake City 84132, USA.
The diagnosis of small round cell neoplasms (SRCN) in children is difficult by both histologic and cytologic methods. These neoplasms are unified morphologically by the scanty cytoplasm surrounding relatively round nuclei containing a primitive chromatin pattern. Further categorization is achieved histologically by the recognition of architectural differentiation and cytoplasmic features. Numerous series and case reports documenting the cytologic features of SRCN have been published in the English-language literature, but relatively few studies have statistically analyzed the diagnostic utility of these features. Our logistic regression analysis of 59 cases of SRCN indicates that the presence of an extremely scanty cytoplasm favors the diagnosis of Ewing's sarcoma (P = 0.004), as does the positive expression of cytoplasmic vacuoles (P = 0.02). Strap or tadpole cells closely correlate with the diagnosis of rhabdomyosarcoma (P < 0.001). The positive expression of rosettes strongly supports the presence of a neuroblastoma (P < 0.001). The diagnosis of Wilms' tumor is confirmed by the expression of tubules (P < 0.001). The presence of lymphoglandular bodies strongly favors the diagnosis of lymphoma (P < 0.001). While some cytologic features are highly correlated with specific SRCN, these features are not invariably present, and definitive diagnosis may require immunohistochemical or ultrastructural analysis performed on cell block material.
PMID: 10319227 [PubMed - indexed for MEDLINE]
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Diagnostic utility of MIC-2 immunocytochemical staining in the differential diagnosis of small blue cell tumors.
Halliday BE, Slagel DD, Elsheikh TE, Silverman JF.
Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, North Carolina, USA.
Ewing's sarcoma (ES) and peripheral neuroectodermal tumor (PNET) are considered in the differential diagnosis of small round blue cell tumors of infancy and childhood which includes neuroblastoma, rhabdomyosarcoma and malignant lymphoma. Fine-needle aspiration diagnosis of these neoplasms can be particularly difficult when the neoplasms are composed of poorly differentiated cells or fail to produce a stroma. MIC-2 is a highly sensitive and specific marker for the PNET/ES group of neoplasms and has been studied extensively in surgical pathology. Other small blue cell neoplasms including rhabdomyosarcoma, blastemal Wilm's tumor, and lymphoblastic lymphoma have also shown positivity, but the staining reactions are usually weak and focal. The utility of this marker in the differential of small blue cell neoplasms in cytologic material has not been examined. Twenty cases of small blue cell neoplasms obtained by fine-needle aspiration (FNA) were studied. MIC-2 antibody was applied retrospectively to formalin-fixed cell block material and destained alcohol-fixed and air-dried cytologic preparations. These cases include primitive neuroectodermal tumor (five cases), Ewing's sarcoma (two cases), neuroblastoma (four cases), Wilms's tumor (four cases), lymphoblastic lymphoma (two cases), and small-cell carcinoma (three cases). The cases were judged positive when the majority of the cells showed cytoplasmic staining. Diffuse cytoplasmic staining was observed in all seven cases of PNET/ES. Staining could be seen on the destained air-dried smears (three cases), fixed smears (two cases), or the cell block material (two cases). None of the other 13 small blue cell neoplasms showed positive staining. We conclude that MIC-2 is a sensitive and specific marker for the PNET/ES group of neoplasms in specimens from formalin-fixed cell block, air-dried, and alcohol-fixed cytologic material and is useful in the differential diagnosis of small blue cell tumors.
PMID: 9839129 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration cytology of extraskeletal Ewing's sarcoma.
Bakhos R, Andrey J, Bhoopalam N, Jensen J, Reyes CV.
Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA.
Extraskeletal Ewing's sarcoma (EES) is a round-cell malignancy that manifests most commonly in the paravertebral and intercostal regions. It occurs predominantly in adolescents and young adults, between the ages of 10 and 30 yr, and follows an aggressive course with a high recurrence rate. Distant metastasis is also common. The tumor is often confused with other round, small-cell neoplasms, including primitive neuroectodermal tumor, neuroblastoma, embryonal rhabdomyosarcoma, and lymphoma. This report pertains to a fine-needle aspiration cytologic diagnosis of EES, supported by clinicopathologic and fine structural correlations in a 56-yr-old man who presented with a rapidly growing, massive, right groin mass. The smears showed a diffuse cellular population of malignant round cells composed of two types: one group of larger cell exhibiting a thin-rim, pale cytoplasm, less hyperchromatic nuclei, nucleoli, and diffusely dispersed chromatinic nuclear details; and the second group of smaller and darker cells with highly hyperchromatic and almost smudged nuclei. These are chief cells and dark cells, respectively. Special studies revealed significant intracytoplasmic glycogen and positive vimentin and HBA-71 immunostaining. Cytogenetic findings of chromosomal 11;22 translocation is also supportive of the diagnosis of EES.
PMID: 9484643 [PubMed - indexed for MEDLINE]
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Pleural effusion cytology of embryonal rhabdomyosarcoma.
Thompson KS, Jensen JD, Bhoopalam N, Reyes CV.
Cytology Section, Veterans Affairs Hospital, Hines, IL 60141, USA.
This case report concerns an embryonal rhabdomyosarcoma of the testis in a 31-yr-old white male patient who underwent radical left orchiectomy, followed by combined irradiation and chemotherapy, and who 2 yr later presented with dyspnea at rest, nonproductive cough, and lower back pain for 1 wk. Chest radiographs demonstrated a bilateral pleural effusion and diffuse infiltrating lesion of the pleurae, mimicking a mesothelioma. The pleural fluid displayed noncohesive, malignant, small, round cells about 2-5 times larger than mature lymphocytes. They had large, darkly stained, pleomorphic nuclei and bubbly cytoplasm with poorly defined borders. The diagnosis of embryonal rhabdomyosarcoma was supported by a positive myosin immunostaining and ultrastructural findings of intracytoplasmic actin and myosin-type microfilaments. Our case is also notable in that the tumor was a pure rhabdomyosarcoma involving a testicular origin, and the patient is the oldest reported in the literature.
PMID: 9099552 [PubMed - indexed for MEDLINE]
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FNA biopsy of small round cell tumors of childhood: cytomorphologic features and the role of ancillary studies.
Silverman JF, Joshi VV.
Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, NC 27858-4354.
Pediatric tumors which are conventionally considered to be small round cell tumors (SRCTs) include the prototypical neuroblastoma as well as rhabdomyosarcoma (RMS), Ewing's sarcoma (ES), malignant lymphoma, and primitive neuroectodermal tumor (PNET). Other malignancies may be considered in the differential diagnosis such as small-cell osteogenic sarcoma, undifferentiated (anaplastic) hepatoblastoma, granulocytic sarcoma, blastemal type Wilms' tumor, and desmoplastic small-cell tumor of the peritoneum. The cytomorphologic features of conventional SRCTs is presented as well as the utility of ancillary studies performed on the aspirated material in making a specific and correct diagnosis. The role of the immediate cytologic assessment of the aspirate is stress, since this is a critical step in formulating an initial diagnostic impression that should prompt the need for additional material for pertinent ancillary studies. Although challenging, FNA cytology of SRCTs of childhood can be diagnostic in the majority of cases, allowing specific therapy to be given to patients with unresectable SRCTs without a tissue biopsy as well as documenting recurrent and/or metastatic disease.
Publication Types:
PMID: 8050333 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration biopsy of childhood rhabdomyosarcoma: reevaluation of the cytologic criteria for diagnosis.
de Almeida M, Stastny JF, Wakely PE Jr, Frable WJ.
Department of Pathology, Instituto Portugues de Oncologia, Lisbon.
The distinction between rhabdomyosarcoma (RMS) and the other small round blue cell tumors of childhood has therapeutic implications which stress the importance of a correct diagnosis. In attempts to reevaluate the cytologic criteria of this entity, we reviewed a series of 17 fine-needle aspiration biopsies and three touch imprints from soft tissue masses. All cases had been histologically confirmed except for two cases that only had immunocytochemical and ultrastructural confirmation. The features occurring most commonly include a uniform population of tumor cells arranged as single cells and cohesive aggregates. The cells were predominantly round/polygonal, with uniform nuclei and scant to moderate amounts of cytoplasm. The nuclear chromatin was most often finely granular and hyperchromatic, while nucleoli were inconspicuous. Binucleated and multinucleated cells were found in 17 of the 20 smears. Intracytoplasmic vacuoles were present in 17 cases, ranging from occasional in one case, a few in 10 cases, and very numerous in six cases. We conclude that the presence of bi/multinucleated cells is an important clue for the diagnosis of RMS on fine-needle aspiration biopsy.
PMID: 7867465 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration biopsy of pediatric neoplasms: correlation between electron microscopy and immunocytochemistry in diagnosis and classification.
Akhtar M, Bedrossian CW, Ali MA, Bakry M.
Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
A series of fine-needle aspiration biopsies performed in 635 children were reviewed. The diagnoses rendered in these patients included malignant lymphoma in 139 (21.9%); Hodgkin's disease, 25 (3.9%); neuroblastoma, 58 (9.1%); Wilms' Tumor, 37 (5.8%); Ewing's sarcoma, 32 (5.0%); rhabdomyosarcoma, 25 (3.9%); retinoblastoma, 22 (3.5%); leukemia infiltrate, 33 (5.2%); and miscellaneous tumors, 52 (8.2%). In 171 patients (26.9%), the biopsy was nondiagnostic. The cytomorphological characteristics of these lesions are briefly described and illustrated. Salient morphological features are further correlated with histological and ultrastructural appearances. Immunocytochemical patterns of these tumors are also discussed briefly.
PMID: 1606883 [PubMed - indexed for MEDLINE]
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Infantile cutaneous rhabdomyosarcoma (Li-Fraumeni syndrome): cytological presentation of fine-needle aspirate biopsy, report of a case.
Perez-Guillermo M, Bonmati-Limorte C, Garcia-Rojo B, Hernandez-Gil A.
Sta. Maria del Rosell Hospital, Cartagena, Spain.
We describe the cytopathological picture of a cutaneous rhabdomyosarcoma located in the left nasal furrow of a 4-mo-old girl, some of whose close relatives have died or suffered from different types of neoplasias (Li-Fraumeni syndrome). We believe that the cytological picture is highly characteristic and rules out other round cell tumours of childhood. We underline the usefulness of FNAC in dermatology and strongly advocate the introduction of this technique into the diagnostic armoury of every dermatologist.
PMID: 1468341 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration biopsy diagnosis of rhabdomyosarcoma: cytologic, histologic, and ultrastructural correlations.
Akhtar M, Ali MA, Bakry M, Hug M, Sackey K.
Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
A series of 15 cases of rhabdomyosarcoma diagnosed by fine-needle aspiration biopsy (FNAB) and confirmed by histopathology is reviewed. Cytologically, the tumors were composed of a variable mixture of cells, which according to the degree of differentiation were categorized as early, intermediate, or late rhabdomyoblasts. Histologically, the tumors were divided into embryonal 9, monomorphic round cell 4, and alveolar rhabdomyosarcoma 2. Comparison of histological and cytological features revealed that embryonal types were composed mainly of early rhabdomyoblasts. Recognition of these patterns may be helpful in FNAB diagnosis of rhabdomyosarcoma.
PMID: 1396025 [PubMed - indexed for MEDLINE]
Comment in:
- Diagn Cytopathol. 1996 Aug;15(2):179-81
Malignant rhabdoid tumor of soft tissues: a cytopathological and immunohistochemical study.
Sola Perez J, Perez-Guillermo M, Bas Bernal A, Manzanera Lopez T, Caro Lopez F.
Department of Cytopathology, Virgen de la Arrixaca University Hospital, Murcia, Spain.
We describe the cytopathological and immunohistochemical features of a primary malignant rhabdoid tumor (MRT) located in the left forehead region of an 8-mo-old female. The cardinal characteristics are hyaline cytoplasmic inclusions, rounded or bean-shaped nucleus, vesicular chromatin, central prominent nucleolus, and poorly defined cytoplasmic profile. Both the cytoplasm and the hyaline inclusion are vimentin and keratin positive, but negative with desmin, S-100 protein, neuron-specific enolase, (NSE) myoglobin, leukocyte common antigen (LCA), and alpha-1-antichymotrypsin. This immunohistochemical pattern, although not exclusive to MRT, is fairly typical of MRT, and when it is assessed in conjunction with cytopathological findings and clinical data permits a confident diagnosis of MRT. We emphasize the utility of immunohistochemical techniques in making the differential diagnosis of MRT against other childhood round-cell tumors.
PMID: 1322263 [PubMed - indexed for MEDLINE]
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Rhabdomyosarcomatous differentiation in a neuroblastoma: a potential pitfall in the cytologic diagnosis of small round-cell tumors of childhood.
Layfield LJ, Glasgow BJ.
Department of Pathology, University of California, Los Angeles 90024-1732.
Rhabdomyoblasts demonstrating immunoreactivity for muscle-specific actin, desmin, and myoglobin were identified in smears obtained by aspiration from a large retroperitoneal mass in a 14-mo-old girl. Following a tentative diagnosis of a rhabdomyogenous neoplasm, retroperitoneal exploration and adrenalectomy demonstrated a stromal poor neuroblastoma with extensive rhabdomyogenous differentiation. The presence of a subpopulation of rhabdomyoblasts was not diagnostic of rhabdomyosarcoma when obtained by fine-needle aspiration from a retroperitoneal tumor composed predominantly of primitive small round cells.
PMID: 2065576 [PubMed - indexed for MEDLINE]
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Undifferentiated small round-cell tumors of childhood: the immunocytochemical demonstration of myogenic differentiation in fine-needle aspirates.
Pettinato G, Swanson PE, Insabato L, De Chiara A, Wick MR.
Department of Pathology, Second Medical School, University of Naples, Italy.
The recognition of myogenic differentiation is not always possible using routine light or electron microscopic techniques. In this article, we describe our experience with two small round-cell neoplasms occurring in young children, each of which exhibited an undifferentiated light microscopic appearance. In both cases, myogenic features were revealed by immunocytochemical methods applied to fine-needle aspiration (FNA) biopsies. Each was immunoreactive for desmin and vimentin and failed to react with antibodies to leukocyte-common antigen. Moreover, formalin-fixed tissue sections of one case were negative for cytokeratin and epithelial membrane antigen. Sporadic reactivity for neuron-specific enolase and Leu-7 antigen was observed in occasional cells in FNA specimens, but synaptophysin was not identified. The rapidity of the method and the reliability of the immunocytochemical findings, when compared with routine cytologic evaluation, emphasize the diagnostic utility of immunocytochemical analysis when FNAs of pediatric soft-tissue tumors are obtained.
PMID: 2476285 [PubMed - indexed for MEDLINE]
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Cytology of embryonal rhabdomyosarcoma: a cytologic, light microscopic, electron microscopic, and immunohistochemical study of seven cases.
Seidal T, Walaas L, Kindblom LG, Angervall L.
Department of Pathology, University of Goteborg, Sahlgren's Hospital, Sweden.
A correlated cytologic and histologic study of seven cases of embryonal rhabdomyosarcoma is presented. The diagnosis of rhabdomyosarcoma was established by light and electron microscopy and immunohistochemistry of the operative specimens. The cytologic appearance of the smears corresponded well with the histopathologic findings. Cytologically, two main cell types were distinguished: a predominant primitive, small round cell with scant cytoplasm and a large cell with an abundant cytoplasm, sometimes tadpole- or ribbon-shaped. The tumor cells were often enclosed in a background of mucosubstances. The lack of cytologic features proving rhabdomyoblastic differentiation, such as cross-striation, necessitates the use of additional methods in the cytologic diagnosis of embryonal rhabdomyosarcoma. The value of the embedding technique for ultrastructural analysis and immunohistochemistry in the demonstration of desmin in aspirates is emphasized in the diagnosis of embryonal rhabdomyosarcoma.
PMID: 3076110 [PubMed - indexed for MEDLINE]
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Fine-needle aspiration cytology of prostatic embryonal rhabdomyosarcoma: a case report.
Henkes DN, Stein N.
Fine-needle aspiration of the prostate has recently gained popularity as a reliable technique in the evaluation of prostatic nodules for malignancy. The cytologic features of adenocarcinoma have been described, but the features of other more unusual tumors have not been widely publicized. We report a case of embryonal rhabdomyosarcoma of the prostate gland with epithelioid cytologic features.
PMID: 3595414 [PubMed - indexed for MEDLINE]
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Differential diagnosis of the pleomorphic aspiration biopsy sample of nonepithelial lesions.
Golouh R, Us-Krasovec M.
The major problem confronting the cytopathologist in interpretation of the pleomorphic aspiration biopsy sample (ABS) of nonepithelial lesions is to provide a reasonable differential diagnosis, since the presence of cellular pleomorphism alone does not always denote malignancy. One must be fully cognizant of a vast number of pathologic processes to make a correct interpretation. Some indication of the extent of the problem and the potential diagnostic pitfalls are outlined in selection of nonneoplastic processes and benign and malignant tumors of mesenchymal origin presenting as pleomorphic ABSs.
PMID: 3013536 [PubMed - indexed for MEDLINE]
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Transthoracic fine needle aspiration of primary and metastatic sarcomas.
Crosby JH, Hooeg K, Hager B.
Sarcomas, excluding lymphomas, are relatively uncommon targets of transthoracic fine needle aspiration. This paper presents a series of 11 adult patients with a variety of histologically documented sarcomas that were positive on transthoracic fine needle aspiration. Most tumors were metastatic from extrathoracic primary sites. We summarize the cytologic appearances of the aspirates and the clinical roles of fine needle aspiration in this setting. The aspirates resembled the corresponding histologic sections in cellular morphology. Nine different histologic types of sarcomas therefore produced a wide variety of cytologic appearances. Two findings, though not specific for sarcomas, were common and are suggested as clues to the recognition of sarcomas: (1) poor cohesion of cells and (2) numerous spindle cells. Transthoracic fine needle aspiration confirmed a strongly suspected clinical diagnosis in 7 cases, and it clarified a more obscure clinical diagnosis in 4 cases. Suggestions are presented for differential diagnosis.
PMID: 3836088 [PubMed - indexed for MEDLINE]
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Congenital alveolar rhabdomyosarcoma: clinical and molecular distinction from alveolar rhabdomyosarcoma in older children.
Grundy R, Anderson J, Gaze M, Gerrard M, Glaser A, Gordon A, Malone M, Pritchard-Jones K, Michalski A.
The Institute of Child Health, The University of Birmingham, Whittall Street, Birmingham B4 6NH, United Kingdom. [email protected]
BACKGROUND: Congenital alveolar rhabdomyosarcoma (RMS) is extremely rare and invariably fatal with current therapy. Its clinical presentation is unusual and is distinct from RMS in older children, with > 50% of patients presenting with multiple cutaneous metastases. To the authors' knowledge, the biology of this condition has not been studied to date. METHODS: The clinical and pathologic findings of four cases of congenital RMS are presented along with those of other cases found in the literature. Molecular analysis was undertaken to detect the characteristic chromosomal translocations of alveolar RMS in three cases with suitable material. RESULTS: To the authors' knowledge, there are no recorded survivors of congenital alveolar RMS. Clinical and histopathologic findings in four patients with congenital alveolar RMS are detailed along with treatment responses. It now is recognized that tumor specific translocations can be detected in the majority of cases of alveolar RMS using the reverse transcriptase-polymerase chain reaction (RT-PCR) method. However, detailed molecular analysis using RT-PCR was unable to detect the presence of either the classic t(2;13) or variant t(1;13) translocation in three cases analyzed at the molecular level. CONCLUSIONS: To the authors' knowledge the optimal treatment for this rare tumor is not known. The longest survivor in the current series underwent myeloablative therapy with peripheral stem cell support, suggesting that more intensive treatment may be of value in this rare condition. None of the three tumors analyzed by RT-PCR harbored characteristic RMS translocations. The molecular biology of this highly malignant and aggressive congenital tumor appears to be different from alveolar RMS in older children and warrants further investigation. Copyright 2001 American Cancer Society.
PMID: 11169945 [PubMed - indexed for MEDLINE]
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