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Scope of FNAC in the diagnosis of soft tissue tumors--a study from a tertiary cancer referral center in India.

Rekhi B, Gorad BD, Kakade AC, Chinoy R - Cytojournal (2007)

Bottom Line: FNAC is fairly specific and sensitive in STT diagnoses for primary, recurrent and metastatic lesions.The cytological types, especially round cell and pleomorphic sarcomas, can be quickly identified.Clinicopathological correlation with ICC as an adjunct, are valuable in exact sub typing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept of Pathology, Tata Memorial Centre, Dr E, B, Road, Parel, Mumbai, 400012, India. rekhi.bharat@gmail.com

ABSTRACT

Background: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in the evaluation of tumors. Its role in diagnosing soft tissue tumors (STT) has been fairly documented, as well as debated. Present study was aimed at evaluating its scope in diagnosing 127 cases of soft tissue tumors.

Methods: Conventional Pap and MGG staining was available in all the cases. Immunocytochemistry (ICC) was performed in 15 cases. Histopathological details were available in 115 cases.

Results: 50% cases were referred for a primary diagnosis, while 26.8% & 22.8% cases were evaluated for recurrent and metastatic lesions, respectively. Extremities were the commonest sites. On FNAC, 101 cases (79.5%) were labeled as malignant, whereas 10 cases (7.9%) were labeled as benign. The remaining 16 cases (11%) were not categorized and were labeled as 'unsure/not specified'. Histopathological confirmation in 115 cases, gave a diagnostic accuracy of 98%, with a positive predictive value of 98% in malignant cases and a negative predictive value of 100% in benign cases. Two cases were false positive. Among the various cytological categories, 60 cases (47.2%) were of spindle cell type, followed by 32 (25.2%) of round cell type and 14 cases (11%) of lipomatous type. Other 12 cases (9.4%) were of pleomorphic type; 7 (5.5%) cases of epithelioid type and remaining 2 cases were of myxoid type. All the round cell, pleomorphic and myxoid type of tumors were sarcomas, whereas 73.3% cases of spindle cell type were labeled as 'malignant'. Exact cytological sub typing was offered in 58 cases, with rhabdomyosarcoma (RMS) as the most frequently sub typed tumor. The two false positive malignant cases were of fibromatosis and a pigmented schwannoma, on biopsy. Out of 28 metastatic lesions, lymph nodes were the commonest site for metastasis, with epithelioid tumors that formed highest percentage of metastatic cases.

Conclusion: FNAC is fairly specific and sensitive in STT diagnoses for primary, recurrent and metastatic lesions. The cytological types, especially round cell and pleomorphic sarcomas, can be quickly identified. Clinicopathological correlation with ICC as an adjunct, are valuable in exact sub typing.

No MeSH data available.


Related in: MedlinePlus

A. Rhabdomyosarcoma (RMS). Hypercellular smear with round cells, including plasmacytoid and binucleate forms (arrow), against a 'lacy' background MGG × 200. B. Smear with singly scattered round cells and an isolated strap cell/tumor rhabdomyoblast (arrow). Pap × 200. C. Diffuse desmin positivity in the round cells. DAB × 400. D. Alveolar RMS. Hypercellular smear with round cells including 'wreath'-like giant cells (inset). Pap × 400. E. High power view of an isolated wreath-like giant cell. Pap × 400. F. Cell block preparation showing strong myogenin expression. DAB × 400. G. PNET. Hypercellular smear with round cells, scattered singly and forming 'rosettes' (arrow). H. Positive MIC2 (CD99) expression in the tumor cells (DAB × 400). I. Neuroblastoma. Smear displaying round cells, with fine nuclear chromatin and exhibiting Homer-wright rosettes. J. High power view of an isolated pseudo rosette. L. Granulocytic sarcoma (formed on biopsy). Malignant round cell tumor, showing blasts. Strong MP0 positivity, on imprint, in the tumor cells. (DAB × 200).
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Figure 2: A. Rhabdomyosarcoma (RMS). Hypercellular smear with round cells, including plasmacytoid and binucleate forms (arrow), against a 'lacy' background MGG × 200. B. Smear with singly scattered round cells and an isolated strap cell/tumor rhabdomyoblast (arrow). Pap × 200. C. Diffuse desmin positivity in the round cells. DAB × 400. D. Alveolar RMS. Hypercellular smear with round cells including 'wreath'-like giant cells (inset). Pap × 400. E. High power view of an isolated wreath-like giant cell. Pap × 400. F. Cell block preparation showing strong myogenin expression. DAB × 400. G. PNET. Hypercellular smear with round cells, scattered singly and forming 'rosettes' (arrow). H. Positive MIC2 (CD99) expression in the tumor cells (DAB × 400). I. Neuroblastoma. Smear displaying round cells, with fine nuclear chromatin and exhibiting Homer-wright rosettes. J. High power view of an isolated pseudo rosette. L. Granulocytic sarcoma (formed on biopsy). Malignant round cell tumor, showing blasts. Strong MP0 positivity, on imprint, in the tumor cells. (DAB × 200).

Mentions: Out of 7 cases of tumors with epithelioid morphology, all were malignant. The cytological diagnoses included 1 case of an epithelioid sarcoma and 1 case of an epithelioid MPNST. Remaining 5 cases were labeled as sarcomas with an epithelioid morphology. On histopathology, 1 of these turned out as a malignant granular cell tumor; 1 epithelioid leiomyosarcoma; 1 Alk1 positive anaplastic large cell lymphoma (ALCL) and another 1 as a pleomorphic sarcoma (NOS). One case turned out to be a myxoid liposarcoma with round/polygonal cells, the latter that were seen in the smears. In the myxoid category, both the tumors were designated as myxofibrosarcomas. (Figures 1, 2, 3, 4). While one of these was in the thigh of a 60 years old male, the other case that turned out as a pleomorphic sarcoma, myxoinflammatory type on biopsy, was identified in the leg of a 52 years old male. (Table No. 1, 2, 3, 4)


Scope of FNAC in the diagnosis of soft tissue tumors--a study from a tertiary cancer referral center in India.

Rekhi B, Gorad BD, Kakade AC, Chinoy R - Cytojournal (2007)

A. Rhabdomyosarcoma (RMS). Hypercellular smear with round cells, including plasmacytoid and binucleate forms (arrow), against a 'lacy' background MGG × 200. B. Smear with singly scattered round cells and an isolated strap cell/tumor rhabdomyoblast (arrow). Pap × 200. C. Diffuse desmin positivity in the round cells. DAB × 400. D. Alveolar RMS. Hypercellular smear with round cells including 'wreath'-like giant cells (inset). Pap × 400. E. High power view of an isolated wreath-like giant cell. Pap × 400. F. Cell block preparation showing strong myogenin expression. DAB × 400. G. PNET. Hypercellular smear with round cells, scattered singly and forming 'rosettes' (arrow). H. Positive MIC2 (CD99) expression in the tumor cells (DAB × 400). I. Neuroblastoma. Smear displaying round cells, with fine nuclear chromatin and exhibiting Homer-wright rosettes. J. High power view of an isolated pseudo rosette. L. Granulocytic sarcoma (formed on biopsy). Malignant round cell tumor, showing blasts. Strong MP0 positivity, on imprint, in the tumor cells. (DAB × 200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2164954&req=5

Figure 2: A. Rhabdomyosarcoma (RMS). Hypercellular smear with round cells, including plasmacytoid and binucleate forms (arrow), against a 'lacy' background MGG × 200. B. Smear with singly scattered round cells and an isolated strap cell/tumor rhabdomyoblast (arrow). Pap × 200. C. Diffuse desmin positivity in the round cells. DAB × 400. D. Alveolar RMS. Hypercellular smear with round cells including 'wreath'-like giant cells (inset). Pap × 400. E. High power view of an isolated wreath-like giant cell. Pap × 400. F. Cell block preparation showing strong myogenin expression. DAB × 400. G. PNET. Hypercellular smear with round cells, scattered singly and forming 'rosettes' (arrow). H. Positive MIC2 (CD99) expression in the tumor cells (DAB × 400). I. Neuroblastoma. Smear displaying round cells, with fine nuclear chromatin and exhibiting Homer-wright rosettes. J. High power view of an isolated pseudo rosette. L. Granulocytic sarcoma (formed on biopsy). Malignant round cell tumor, showing blasts. Strong MP0 positivity, on imprint, in the tumor cells. (DAB × 200).
Mentions: Out of 7 cases of tumors with epithelioid morphology, all were malignant. The cytological diagnoses included 1 case of an epithelioid sarcoma and 1 case of an epithelioid MPNST. Remaining 5 cases were labeled as sarcomas with an epithelioid morphology. On histopathology, 1 of these turned out as a malignant granular cell tumor; 1 epithelioid leiomyosarcoma; 1 Alk1 positive anaplastic large cell lymphoma (ALCL) and another 1 as a pleomorphic sarcoma (NOS). One case turned out to be a myxoid liposarcoma with round/polygonal cells, the latter that were seen in the smears. In the myxoid category, both the tumors were designated as myxofibrosarcomas. (Figures 1, 2, 3, 4). While one of these was in the thigh of a 60 years old male, the other case that turned out as a pleomorphic sarcoma, myxoinflammatory type on biopsy, was identified in the leg of a 52 years old male. (Table No. 1, 2, 3, 4)

Bottom Line: FNAC is fairly specific and sensitive in STT diagnoses for primary, recurrent and metastatic lesions.The cytological types, especially round cell and pleomorphic sarcomas, can be quickly identified.Clinicopathological correlation with ICC as an adjunct, are valuable in exact sub typing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept of Pathology, Tata Memorial Centre, Dr E, B, Road, Parel, Mumbai, 400012, India. rekhi.bharat@gmail.com

ABSTRACT

Background: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in the evaluation of tumors. Its role in diagnosing soft tissue tumors (STT) has been fairly documented, as well as debated. Present study was aimed at evaluating its scope in diagnosing 127 cases of soft tissue tumors.

Methods: Conventional Pap and MGG staining was available in all the cases. Immunocytochemistry (ICC) was performed in 15 cases. Histopathological details were available in 115 cases.

Results: 50% cases were referred for a primary diagnosis, while 26.8% & 22.8% cases were evaluated for recurrent and metastatic lesions, respectively. Extremities were the commonest sites. On FNAC, 101 cases (79.5%) were labeled as malignant, whereas 10 cases (7.9%) were labeled as benign. The remaining 16 cases (11%) were not categorized and were labeled as 'unsure/not specified'. Histopathological confirmation in 115 cases, gave a diagnostic accuracy of 98%, with a positive predictive value of 98% in malignant cases and a negative predictive value of 100% in benign cases. Two cases were false positive. Among the various cytological categories, 60 cases (47.2%) were of spindle cell type, followed by 32 (25.2%) of round cell type and 14 cases (11%) of lipomatous type. Other 12 cases (9.4%) were of pleomorphic type; 7 (5.5%) cases of epithelioid type and remaining 2 cases were of myxoid type. All the round cell, pleomorphic and myxoid type of tumors were sarcomas, whereas 73.3% cases of spindle cell type were labeled as 'malignant'. Exact cytological sub typing was offered in 58 cases, with rhabdomyosarcoma (RMS) as the most frequently sub typed tumor. The two false positive malignant cases were of fibromatosis and a pigmented schwannoma, on biopsy. Out of 28 metastatic lesions, lymph nodes were the commonest site for metastasis, with epithelioid tumors that formed highest percentage of metastatic cases.

Conclusion: FNAC is fairly specific and sensitive in STT diagnoses for primary, recurrent and metastatic lesions. The cytological types, especially round cell and pleomorphic sarcomas, can be quickly identified. Clinicopathological correlation with ICC as an adjunct, are valuable in exact sub typing.

No MeSH data available.


Related in: MedlinePlus