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Intravascular papillary endothelial hyperplasia diagnosed by fine needle aspiration: Report of a case and cytology literature review.

Kovalovsky A, Reynders A, Khurana K - J Cytol (2013)

Bottom Line: The endothelial cells were positive for CD34 and factor VIII, supporting the cytological diagnosis of IVPEH.Surgical excision confirmed the diagnosis.To the best of our knowledge, this is the first reported case of IVPEH diagnosed by preoperative FNA.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, State University of New York, USA.

ABSTRACT
Intravascular papillary endothelial hyperplasia (IVPEH) is an unusual form of intravascular endothelial proliferation. Fine needle aspiration (FNA) diagnosis of IVPEH is quite challenging and only rare reports of the cytopathological features of this entity have been published. We report a case of a 55-year-old female patient who presented with a mass on her left jaw. FNA of the mass revealed pleomorphic polygonal and spindle cells. A preliminary (onsite) cytological diagnosis of suspicious for malignancy was rendered. Subsequent cell block showed delicate papillae composed of attenuated endothelial cells overlying collagenized cores. The endothelial cells were positive for CD34 and factor VIII, supporting the cytological diagnosis of IVPEH. Surgical excision confirmed the diagnosis. To the best of our knowledge, this is the first reported case of IVPEH diagnosed by preoperative FNA.

No MeSH data available.


Related in: MedlinePlus

Metachromatic hyaline globules (Diff Quik stain, ×400)
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Figure 3: Metachromatic hyaline globules (Diff Quik stain, ×400)

Mentions: The smears revealed isolated clusters of pleomorphic polygonal cells and sheets of spindle cells in a hemorrhagic background. Polygonal cells with abundant pale cytoplasm exhibited anisonucleosis, increased nuclear cytoplasmic ratio, overlapping nuclei and irregular nuclear contours [Figure 1]. Spindle cells with elongated oval nuclei and scant cytoplasm surrounded metachromatic hyaline globules and hyaline stalks [Figures 2 and 3]. No necrosis or atypical mitoses were seen. Due to patient's prior history of papillary carcinoma, we considered the cytological findings suspicious for malignancy at the time of onsite evaluation and also raised the possibility of recurrence of papillary carcinoma with anaplastic features at the time of onsite evaluation. Subsequent cell block showed characteristic features of IVPEH characterized by papillary cores lined by plump endothelial cells, adjacent to small delicate papillae [Figure 4]. The papillae were composed of attenuated endothelial cells overlying hyalinized cores. The endothelial cells maintained the polygonal or spindle shape noted in the aspirate smears. Abundant cytoplasm and large, pleomorphic nuclei were occasionally identified. No mitotic activity was noted. Immunohistochemical stains for factor VIII and CD34 performed on the cell block material outlined the endothelial cells [Figure 5]. Final cytology was reported as consistent with IVPEH.


Intravascular papillary endothelial hyperplasia diagnosed by fine needle aspiration: Report of a case and cytology literature review.

Kovalovsky A, Reynders A, Khurana K - J Cytol (2013)

Metachromatic hyaline globules (Diff Quik stain, ×400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643361&req=5

Figure 3: Metachromatic hyaline globules (Diff Quik stain, ×400)
Mentions: The smears revealed isolated clusters of pleomorphic polygonal cells and sheets of spindle cells in a hemorrhagic background. Polygonal cells with abundant pale cytoplasm exhibited anisonucleosis, increased nuclear cytoplasmic ratio, overlapping nuclei and irregular nuclear contours [Figure 1]. Spindle cells with elongated oval nuclei and scant cytoplasm surrounded metachromatic hyaline globules and hyaline stalks [Figures 2 and 3]. No necrosis or atypical mitoses were seen. Due to patient's prior history of papillary carcinoma, we considered the cytological findings suspicious for malignancy at the time of onsite evaluation and also raised the possibility of recurrence of papillary carcinoma with anaplastic features at the time of onsite evaluation. Subsequent cell block showed characteristic features of IVPEH characterized by papillary cores lined by plump endothelial cells, adjacent to small delicate papillae [Figure 4]. The papillae were composed of attenuated endothelial cells overlying hyalinized cores. The endothelial cells maintained the polygonal or spindle shape noted in the aspirate smears. Abundant cytoplasm and large, pleomorphic nuclei were occasionally identified. No mitotic activity was noted. Immunohistochemical stains for factor VIII and CD34 performed on the cell block material outlined the endothelial cells [Figure 5]. Final cytology was reported as consistent with IVPEH.

Bottom Line: The endothelial cells were positive for CD34 and factor VIII, supporting the cytological diagnosis of IVPEH.Surgical excision confirmed the diagnosis.To the best of our knowledge, this is the first reported case of IVPEH diagnosed by preoperative FNA.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, State University of New York, USA.

ABSTRACT
Intravascular papillary endothelial hyperplasia (IVPEH) is an unusual form of intravascular endothelial proliferation. Fine needle aspiration (FNA) diagnosis of IVPEH is quite challenging and only rare reports of the cytopathological features of this entity have been published. We report a case of a 55-year-old female patient who presented with a mass on her left jaw. FNA of the mass revealed pleomorphic polygonal and spindle cells. A preliminary (onsite) cytological diagnosis of suspicious for malignancy was rendered. Subsequent cell block showed delicate papillae composed of attenuated endothelial cells overlying collagenized cores. The endothelial cells were positive for CD34 and factor VIII, supporting the cytological diagnosis of IVPEH. Surgical excision confirmed the diagnosis. To the best of our knowledge, this is the first reported case of IVPEH diagnosed by preoperative FNA.

No MeSH data available.


Related in: MedlinePlus