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Fine needle aspiration cytology of lesions of liver and gallbladder: An analysis of 400 consecutive aspirations.

Barbhuiya M, Bhunia S, Kakkar M, Shrivastava B, Tiwari PK, Gupta S - J Cytol (2014)

Bottom Line: An attempt was made to analyze inconclusive and inadequate aspirations.Out of 400 aspirations, 289 (72.2%) were adequate, 75 (18.7%), inconclusive and 36 (9%), inadequate.FNAC can be used successfully for the diagnosis of liver and gallbladder lesions, thus avoiding open biopsy.

View Article: PubMed Central - PubMed

Affiliation: Centre for Genomics, Jiwaji University, Gwalior, Madhya Pradesh, India.

ABSTRACT

Background: Patients presenting with mass lesions of liver and gallbladder are a common occurrence in a cancer hospital in north central part of India. Fine-needle aspiration cytology (FNAC) serves as first line of pathological investigations, but there are pros and cons involved.

Aim: The main objective of the present study was to establish adequacy of the procedure and to find out diagnostic pitfalls. An attempt was made to analyze inconclusive and inadequate aspirations.

Materials and methods: A total of 400 consecutive fine-needle aspirates of liver, belonging to 328 cases over a period of 2 years, were analyzed. Hematoxylin and eosin and May-Grόnwald-Giemsa stains were used. Chi-square test was carried out to compare significant degree of difference in different kind of diagnosis.

Results: Out of 400 aspirations, 289 (72.2%) were adequate, 75 (18.7%), inconclusive and 36 (9%), inadequate. Among positive aspirations the most common was metastatic adenocarcinoma, 128 (44.2%). The positive diagnosis and adequate aspirations were significantly high (P < 0.0001). Major differential diagnostic problems were: Distinguishing the poorly differentiated hepatocellular carcinoma from the metastatic adenocarcinoma; and leukemia/lymphoma from other malignant round cell tumors. Common diagnostic pitfalls were repeated aspirations from the necrotic area and aspiration of atypical, disorganized and reactive hepatocytes, adjacent to a metastasis. No complications were observed.

Conclusion: FNAC can be used successfully for the diagnosis of liver and gallbladder lesions, thus avoiding open biopsy. Study indicates the potential of using FNAC in clinical intervention where the incidence of gall-bladder and liver cancer is very high and open biopsy and surgery are not an option.

No MeSH data available.


Related in: MedlinePlus

(a) A cluster of large pleomorphic cells with abundant cytoplasm, vesicular nuclei and prominent nucleoli in an aspirate from a case of hepatocellular carcinoma (MGG, ×400). (b) Mucus secreting adenocarcinomatous metastasis showing a loose cluster of markedly pleomorphic vesicular cells with abundant cytoplasm and indistinct cell borders (MGG, ×00). (c) Metastatic ductal carcinoma breast showing cohesive cell cluster. Nuclei are vesicular and overlapping (H and E, ×400). (d) A cohesive cluster of mildly pleomorphic hyperchromatic adenocarcinomatous cells with minimal cytoplasm from a case of gallbladder adenosquamous carcinoma (MGG, ×400). (e) Malignant squamous cells from the above case have hyperchromatic nuclei and abundant glassy-blue cytoplasm (MGG, ×400). (f) Metastatic small cell anaplastic carcinoma from lung showing a cohesive cluster of hyperchromatic cells; nuclear molding can be appreciated (MGG, ×400). (g) Metastatic malignant round cell tumor showing a cluster of round-ovoid cells with scanty cytoplasm. Rosettes are evident (MGG, ×400). (h) Infiltration of Non-Hodgkins lymphoma cells: Discretely present large cells have irregular nuclear membrane and prominent nucleoli (H and E, ×400). (i) Metastatic spindle cell sarcoma showing a “microbiopsy” of ovoid — spindle cells; discrete cells present at the periphery (MGG, ×100)
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Figure 1: (a) A cluster of large pleomorphic cells with abundant cytoplasm, vesicular nuclei and prominent nucleoli in an aspirate from a case of hepatocellular carcinoma (MGG, ×400). (b) Mucus secreting adenocarcinomatous metastasis showing a loose cluster of markedly pleomorphic vesicular cells with abundant cytoplasm and indistinct cell borders (MGG, ×00). (c) Metastatic ductal carcinoma breast showing cohesive cell cluster. Nuclei are vesicular and overlapping (H and E, ×400). (d) A cohesive cluster of mildly pleomorphic hyperchromatic adenocarcinomatous cells with minimal cytoplasm from a case of gallbladder adenosquamous carcinoma (MGG, ×400). (e) Malignant squamous cells from the above case have hyperchromatic nuclei and abundant glassy-blue cytoplasm (MGG, ×400). (f) Metastatic small cell anaplastic carcinoma from lung showing a cohesive cluster of hyperchromatic cells; nuclear molding can be appreciated (MGG, ×400). (g) Metastatic malignant round cell tumor showing a cluster of round-ovoid cells with scanty cytoplasm. Rosettes are evident (MGG, ×400). (h) Infiltration of Non-Hodgkins lymphoma cells: Discretely present large cells have irregular nuclear membrane and prominent nucleoli (H and E, ×400). (i) Metastatic spindle cell sarcoma showing a “microbiopsy” of ovoid — spindle cells; discrete cells present at the periphery (MGG, ×100)

Mentions: Adequate aspirations (289, 72.25%) included non-neoplastic cases (7, 2.2%) and neoplastic cases (282, 96.9%). The identification of neoplastic cases is statistically significant with P < 0.0001 at degree of freedom 1 having Chi-square value of 259.78. The distribution of adequate aspirations is given in Table 2. The statistical distribution of non-neoplastic lesions is non-significant due to very small number of cases in the category. The distribution of primary (25, 8.6%) and metastatic (257, 88.9%) shows that a significant number of metastatic lesions can be identified with the adequate aspirations (Chi-square statistic = 189.2 at the degree of freedom 1 and P < 0.0001). Adenocarcinomas contributed majority (174 of 257 cases) of metastatic neoplastic lesions. Metastatic adenocarcinoma from GIT formed the majority of cases (128), followed by gall-bladder carcinoma (46) and undifferentiated malignancy (39). The Chi-square distribution shows that FNAC can significantly differentiate these cytological categories from each other [Table 2] abundant eosinophilic cytoplasm, polygonal shape and large vesicular nuclei with prominent central nucleoli characterized hepatocellular carcinoma. Cells were arranged in sheets and clusters with acinar pattern or in trabecular pattern. Eosinophilic intranuclear inclusions were also present [Figure 1a]. Metastatic adenocarcinoma cells from gastrointestinal tumor had abundant cytoplasm and large vesicular nuclei in loose clusters and groups. Metachromatic cytoplasmic granules were present in some cases [Figure 1b]. Metastasis from a case of ductal carcinoma breast showed cohesive clusters of cells with moderately pleomorphic overlapping nuclei [Figure 1c]. Gallbladder adenosquamous carcinoma had sheets of adenocarcinoma cells [Figure 1d] characterized by mildly pleomorphic cells with a moderate amount of cytoplasm and discretely present malignant squamous cells [Figure 1e] with hyperchromatic nuclei and abundant glassy to blue cytoplasm. At places, adenocarcinomatous cells were tightly pressed against each other and had faceted nuclei. Nucleoli were prominent in high-grade tumors. Tight clusters of hyperchromatic cells with scanty cytoplasm and nuclear molding were seen in small cell carcinoma from lung [Figure 1f]. Smears from liver mass of a 2-year-old female patient showed small monomorphic malignant cells with round hyperchromatic nuclei and scanty cytoplasm. Rosette-like spaces were evident. Metastatic neuroblastoma was suspected [Figure 1g]. Discretely present centrocytic-centroblastic cells with prominent nucleoli suggested a non-Hodgkins lymphoma [Figure 1h]. Lymphoid globules could be appreciated better in Giemsa stained smears. Metastatic sarcomas showed a cohesive tissue fragment of ovoid to spindly cells with indistinct cytoplasm [Figure 1i]. Metastatic germ cell tumor cells from a case of testicular mass had clusters of moderately pleomorphic cells with discernible cytoplasm. Lymphocytes were also present.


Fine needle aspiration cytology of lesions of liver and gallbladder: An analysis of 400 consecutive aspirations.

Barbhuiya M, Bhunia S, Kakkar M, Shrivastava B, Tiwari PK, Gupta S - J Cytol (2014)

(a) A cluster of large pleomorphic cells with abundant cytoplasm, vesicular nuclei and prominent nucleoli in an aspirate from a case of hepatocellular carcinoma (MGG, ×400). (b) Mucus secreting adenocarcinomatous metastasis showing a loose cluster of markedly pleomorphic vesicular cells with abundant cytoplasm and indistinct cell borders (MGG, ×00). (c) Metastatic ductal carcinoma breast showing cohesive cell cluster. Nuclei are vesicular and overlapping (H and E, ×400). (d) A cohesive cluster of mildly pleomorphic hyperchromatic adenocarcinomatous cells with minimal cytoplasm from a case of gallbladder adenosquamous carcinoma (MGG, ×400). (e) Malignant squamous cells from the above case have hyperchromatic nuclei and abundant glassy-blue cytoplasm (MGG, ×400). (f) Metastatic small cell anaplastic carcinoma from lung showing a cohesive cluster of hyperchromatic cells; nuclear molding can be appreciated (MGG, ×400). (g) Metastatic malignant round cell tumor showing a cluster of round-ovoid cells with scanty cytoplasm. Rosettes are evident (MGG, ×400). (h) Infiltration of Non-Hodgkins lymphoma cells: Discretely present large cells have irregular nuclear membrane and prominent nucleoli (H and E, ×400). (i) Metastatic spindle cell sarcoma showing a “microbiopsy” of ovoid — spindle cells; discrete cells present at the periphery (MGG, ×100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150337&req=5

Figure 1: (a) A cluster of large pleomorphic cells with abundant cytoplasm, vesicular nuclei and prominent nucleoli in an aspirate from a case of hepatocellular carcinoma (MGG, ×400). (b) Mucus secreting adenocarcinomatous metastasis showing a loose cluster of markedly pleomorphic vesicular cells with abundant cytoplasm and indistinct cell borders (MGG, ×00). (c) Metastatic ductal carcinoma breast showing cohesive cell cluster. Nuclei are vesicular and overlapping (H and E, ×400). (d) A cohesive cluster of mildly pleomorphic hyperchromatic adenocarcinomatous cells with minimal cytoplasm from a case of gallbladder adenosquamous carcinoma (MGG, ×400). (e) Malignant squamous cells from the above case have hyperchromatic nuclei and abundant glassy-blue cytoplasm (MGG, ×400). (f) Metastatic small cell anaplastic carcinoma from lung showing a cohesive cluster of hyperchromatic cells; nuclear molding can be appreciated (MGG, ×400). (g) Metastatic malignant round cell tumor showing a cluster of round-ovoid cells with scanty cytoplasm. Rosettes are evident (MGG, ×400). (h) Infiltration of Non-Hodgkins lymphoma cells: Discretely present large cells have irregular nuclear membrane and prominent nucleoli (H and E, ×400). (i) Metastatic spindle cell sarcoma showing a “microbiopsy” of ovoid — spindle cells; discrete cells present at the periphery (MGG, ×100)
Mentions: Adequate aspirations (289, 72.25%) included non-neoplastic cases (7, 2.2%) and neoplastic cases (282, 96.9%). The identification of neoplastic cases is statistically significant with P < 0.0001 at degree of freedom 1 having Chi-square value of 259.78. The distribution of adequate aspirations is given in Table 2. The statistical distribution of non-neoplastic lesions is non-significant due to very small number of cases in the category. The distribution of primary (25, 8.6%) and metastatic (257, 88.9%) shows that a significant number of metastatic lesions can be identified with the adequate aspirations (Chi-square statistic = 189.2 at the degree of freedom 1 and P < 0.0001). Adenocarcinomas contributed majority (174 of 257 cases) of metastatic neoplastic lesions. Metastatic adenocarcinoma from GIT formed the majority of cases (128), followed by gall-bladder carcinoma (46) and undifferentiated malignancy (39). The Chi-square distribution shows that FNAC can significantly differentiate these cytological categories from each other [Table 2] abundant eosinophilic cytoplasm, polygonal shape and large vesicular nuclei with prominent central nucleoli characterized hepatocellular carcinoma. Cells were arranged in sheets and clusters with acinar pattern or in trabecular pattern. Eosinophilic intranuclear inclusions were also present [Figure 1a]. Metastatic adenocarcinoma cells from gastrointestinal tumor had abundant cytoplasm and large vesicular nuclei in loose clusters and groups. Metachromatic cytoplasmic granules were present in some cases [Figure 1b]. Metastasis from a case of ductal carcinoma breast showed cohesive clusters of cells with moderately pleomorphic overlapping nuclei [Figure 1c]. Gallbladder adenosquamous carcinoma had sheets of adenocarcinoma cells [Figure 1d] characterized by mildly pleomorphic cells with a moderate amount of cytoplasm and discretely present malignant squamous cells [Figure 1e] with hyperchromatic nuclei and abundant glassy to blue cytoplasm. At places, adenocarcinomatous cells were tightly pressed against each other and had faceted nuclei. Nucleoli were prominent in high-grade tumors. Tight clusters of hyperchromatic cells with scanty cytoplasm and nuclear molding were seen in small cell carcinoma from lung [Figure 1f]. Smears from liver mass of a 2-year-old female patient showed small monomorphic malignant cells with round hyperchromatic nuclei and scanty cytoplasm. Rosette-like spaces were evident. Metastatic neuroblastoma was suspected [Figure 1g]. Discretely present centrocytic-centroblastic cells with prominent nucleoli suggested a non-Hodgkins lymphoma [Figure 1h]. Lymphoid globules could be appreciated better in Giemsa stained smears. Metastatic sarcomas showed a cohesive tissue fragment of ovoid to spindly cells with indistinct cytoplasm [Figure 1i]. Metastatic germ cell tumor cells from a case of testicular mass had clusters of moderately pleomorphic cells with discernible cytoplasm. Lymphocytes were also present.

Bottom Line: An attempt was made to analyze inconclusive and inadequate aspirations.Out of 400 aspirations, 289 (72.2%) were adequate, 75 (18.7%), inconclusive and 36 (9%), inadequate.FNAC can be used successfully for the diagnosis of liver and gallbladder lesions, thus avoiding open biopsy.

View Article: PubMed Central - PubMed

Affiliation: Centre for Genomics, Jiwaji University, Gwalior, Madhya Pradesh, India.

ABSTRACT

Background: Patients presenting with mass lesions of liver and gallbladder are a common occurrence in a cancer hospital in north central part of India. Fine-needle aspiration cytology (FNAC) serves as first line of pathological investigations, but there are pros and cons involved.

Aim: The main objective of the present study was to establish adequacy of the procedure and to find out diagnostic pitfalls. An attempt was made to analyze inconclusive and inadequate aspirations.

Materials and methods: A total of 400 consecutive fine-needle aspirates of liver, belonging to 328 cases over a period of 2 years, were analyzed. Hematoxylin and eosin and May-Grόnwald-Giemsa stains were used. Chi-square test was carried out to compare significant degree of difference in different kind of diagnosis.

Results: Out of 400 aspirations, 289 (72.2%) were adequate, 75 (18.7%), inconclusive and 36 (9%), inadequate. Among positive aspirations the most common was metastatic adenocarcinoma, 128 (44.2%). The positive diagnosis and adequate aspirations were significantly high (P < 0.0001). Major differential diagnostic problems were: Distinguishing the poorly differentiated hepatocellular carcinoma from the metastatic adenocarcinoma; and leukemia/lymphoma from other malignant round cell tumors. Common diagnostic pitfalls were repeated aspirations from the necrotic area and aspiration of atypical, disorganized and reactive hepatocytes, adjacent to a metastasis. No complications were observed.

Conclusion: FNAC can be used successfully for the diagnosis of liver and gallbladder lesions, thus avoiding open biopsy. Study indicates the potential of using FNAC in clinical intervention where the incidence of gall-bladder and liver cancer is very high and open biopsy and surgery are not an option.

No MeSH data available.


Related in: MedlinePlus