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Ultrasound-guided aspiration cytology of retroperitoneal masses with histopathological corroboration: A study of 71 cases.

Chakrabarti I, Bhowmik S, Sinha MG, Bera P - J Cytol (2014)

Bottom Line: Out of 71 cases, 48 cases (67.6%) were found to be neoplastic.Some uncommon retroperitoneal lesions like adrenal myelolipoma, renal angiomyolipoma, Burkitt's lymphoma and adrenocortical carcinoma were found in our study.Guided FNAC could diagnose all the malignant lesions with 100% accuracy except in 2 cases of poorly differentiated carcinoma which came out to be non-Hodgkin lymphoma on subsequent biopsies.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.

ABSTRACT

Background: Diagnosis of retroperitoneal lesions is one of the most difficult areas in surgical pathology. Both primary and metastatic tumors can grow silently in retroperitoneum before the appearance of clinical signs and symptoms. Guided aspiration cytology has shown a promising role in diagnosis of lesions in this region.

Aims: This study was undertaken to evaluate the reliability of guided fine-needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal masses and to study the spectrum of retroperitoneal lesions in a rural tertiary care hospital.

Materials and methods: This study was done on 71 patients presenting with retroperitoneal masses over a period of 20 months in a tertiary care hospital. Ultrasound-guided FNAC was done and the smears were stained by MGG and H and E stains. Histopathological corroboration could be done on all neoplastic lesions along with some non-neoplastic lesions.

Results: Out of 71 cases, 48 cases (67.6%) were found to be neoplastic. Malignant tumors (35 cases) were more common than benign ones (13 cases). Malignant lesions were predominantly composed of lesions of lymph node (17 cases i.e. 48.57%) followed by sarcomas (5 cases) and germ cell tumors. Some uncommon retroperitoneal lesions like adrenal myelolipoma, renal angiomyolipoma, Burkitt's lymphoma and adrenocortical carcinoma were found in our study. Guided FNAC could diagnose all the malignant lesions with 100% accuracy except in 2 cases of poorly differentiated carcinoma which came out to be non-Hodgkin lymphoma on subsequent biopsies.

Conclusion: Guided FNAC is an inexpensive, rapid and reliable method for diagnosis of retroperitoneal masses.

No MeSH data available.


Related in: MedlinePlus

(a) Spindle cells with bland nuclei and mild pleomorphism suggestive of fibromatosis (MGG, ×400); (b) Adrenal myelolipoma showing hematopoietic elements (a megakaryocyte is shown by arrow) in a background containing lipid droplets (MGG, ×400); (c) Burkitt's lymphoma showing dense basophilic cytoplasm with vacuoles (arrow highlighting a mitotic figure) (MGG,×1000); (d) Pleomorphic dyscohesive spindle cells with giant cells (inset) in a case of pleomorphic sarcoma (MGG, ×400)
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Figure 1: (a) Spindle cells with bland nuclei and mild pleomorphism suggestive of fibromatosis (MGG, ×400); (b) Adrenal myelolipoma showing hematopoietic elements (a megakaryocyte is shown by arrow) in a background containing lipid droplets (MGG, ×400); (c) Burkitt's lymphoma showing dense basophilic cytoplasm with vacuoles (arrow highlighting a mitotic figure) (MGG,×1000); (d) Pleomorphic dyscohesive spindle cells with giant cells (inset) in a case of pleomorphic sarcoma (MGG, ×400)

Mentions: Among the benign tumors, soft tissue tumors predominated (69.23%) with lipomas making the largest single sub-group (4 cases, 44.44%). This was followed by fibromatosis (2 cases, 22.22%) [Figure 1a]. In the remaining 3 cases, benign spindle cell lesion was diagnosed cytologically. One case showed benign spindle cells admixed with intercellular collagen with fibrillar appearance in which a diagnosis of benign spindle cell lesion with a probability of schwannoma was made, which was subsequently confirmed on histopathology. Other two cases were histopathologically diagnosed as one case each of neurofibroma and benign fibrous histiocytoma. Two cases of retroperitoneal teratoma were diagnosed, both of which showed the presence of keratinous debris and anucleate squames. One of them also showed mature squamous epithelium. One case of adrenal angiomyolipoma was seen, which yielded loosely clustered spindle cells in a background of fat droplets from a renal mass. The case of adrenal myelolipoma was also interesting with the aspirate showing a combination of hematopoietic cells including megakaryocytes with fat droplets [Figure 1b]. The efficacy of FNAC in diagnosing tumors of adrenal glands were thus similar to the study of Jhala et al.[7]


Ultrasound-guided aspiration cytology of retroperitoneal masses with histopathological corroboration: A study of 71 cases.

Chakrabarti I, Bhowmik S, Sinha MG, Bera P - J Cytol (2014)

(a) Spindle cells with bland nuclei and mild pleomorphism suggestive of fibromatosis (MGG, ×400); (b) Adrenal myelolipoma showing hematopoietic elements (a megakaryocyte is shown by arrow) in a background containing lipid droplets (MGG, ×400); (c) Burkitt's lymphoma showing dense basophilic cytoplasm with vacuoles (arrow highlighting a mitotic figure) (MGG,×1000); (d) Pleomorphic dyscohesive spindle cells with giant cells (inset) in a case of pleomorphic sarcoma (MGG, ×400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150336&req=5

Figure 1: (a) Spindle cells with bland nuclei and mild pleomorphism suggestive of fibromatosis (MGG, ×400); (b) Adrenal myelolipoma showing hematopoietic elements (a megakaryocyte is shown by arrow) in a background containing lipid droplets (MGG, ×400); (c) Burkitt's lymphoma showing dense basophilic cytoplasm with vacuoles (arrow highlighting a mitotic figure) (MGG,×1000); (d) Pleomorphic dyscohesive spindle cells with giant cells (inset) in a case of pleomorphic sarcoma (MGG, ×400)
Mentions: Among the benign tumors, soft tissue tumors predominated (69.23%) with lipomas making the largest single sub-group (4 cases, 44.44%). This was followed by fibromatosis (2 cases, 22.22%) [Figure 1a]. In the remaining 3 cases, benign spindle cell lesion was diagnosed cytologically. One case showed benign spindle cells admixed with intercellular collagen with fibrillar appearance in which a diagnosis of benign spindle cell lesion with a probability of schwannoma was made, which was subsequently confirmed on histopathology. Other two cases were histopathologically diagnosed as one case each of neurofibroma and benign fibrous histiocytoma. Two cases of retroperitoneal teratoma were diagnosed, both of which showed the presence of keratinous debris and anucleate squames. One of them also showed mature squamous epithelium. One case of adrenal angiomyolipoma was seen, which yielded loosely clustered spindle cells in a background of fat droplets from a renal mass. The case of adrenal myelolipoma was also interesting with the aspirate showing a combination of hematopoietic cells including megakaryocytes with fat droplets [Figure 1b]. The efficacy of FNAC in diagnosing tumors of adrenal glands were thus similar to the study of Jhala et al.[7]

Bottom Line: Out of 71 cases, 48 cases (67.6%) were found to be neoplastic.Some uncommon retroperitoneal lesions like adrenal myelolipoma, renal angiomyolipoma, Burkitt's lymphoma and adrenocortical carcinoma were found in our study.Guided FNAC could diagnose all the malignant lesions with 100% accuracy except in 2 cases of poorly differentiated carcinoma which came out to be non-Hodgkin lymphoma on subsequent biopsies.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.

ABSTRACT

Background: Diagnosis of retroperitoneal lesions is one of the most difficult areas in surgical pathology. Both primary and metastatic tumors can grow silently in retroperitoneum before the appearance of clinical signs and symptoms. Guided aspiration cytology has shown a promising role in diagnosis of lesions in this region.

Aims: This study was undertaken to evaluate the reliability of guided fine-needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal masses and to study the spectrum of retroperitoneal lesions in a rural tertiary care hospital.

Materials and methods: This study was done on 71 patients presenting with retroperitoneal masses over a period of 20 months in a tertiary care hospital. Ultrasound-guided FNAC was done and the smears were stained by MGG and H and E stains. Histopathological corroboration could be done on all neoplastic lesions along with some non-neoplastic lesions.

Results: Out of 71 cases, 48 cases (67.6%) were found to be neoplastic. Malignant tumors (35 cases) were more common than benign ones (13 cases). Malignant lesions were predominantly composed of lesions of lymph node (17 cases i.e. 48.57%) followed by sarcomas (5 cases) and germ cell tumors. Some uncommon retroperitoneal lesions like adrenal myelolipoma, renal angiomyolipoma, Burkitt's lymphoma and adrenocortical carcinoma were found in our study. Guided FNAC could diagnose all the malignant lesions with 100% accuracy except in 2 cases of poorly differentiated carcinoma which came out to be non-Hodgkin lymphoma on subsequent biopsies.

Conclusion: Guided FNAC is an inexpensive, rapid and reliable method for diagnosis of retroperitoneal masses.

No MeSH data available.


Related in: MedlinePlus