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Fine Needle Aspiration Cytology: Interpretation and Diagnostic Difficulties
Pranab Dey
CHAPTER 1:
Introduction and Approach to Fine Needle Aspiration Cytology
COMPLICATIONS
FINE NEEDLE ASPIRATION TECHNIQUE
EVALUATION OF FNAC SMEAR
CELL MORPHOLOGY
NUCLEUS7,8
CYTOPLASM
BACKGROUND ACELLULAR MATERIALS9
Diagnostic Difficulties
CHAPTER 2:
Head, Neck, Orbit and Salivary Glands
HEAD AND NECK
NON-NEOPLASTIC LESIONS
Diagnostic Difficulties
NEOPLASTIC LESIONS
Paraganglioma3
Diagnostic Difficulties
Nasopharyngeal Carcinoma4
Diagnostic Difficulties
Ameloblastoma5 (Figure 2.4)
Parathyroid Tumors6,7
Diagnostic Difficulty
Meningioma8,9
Diagnostic Difficulties
SALIVARY GLAND
Clinical History
Aspirated Material
Normal Salivary Gland Cells
Diagnostic Difficulties
Lesions of the Salivary Gland
Sialadenosis
Cysts
Acute Sialadenitis
Chronic Sialadenitis18–20
Autoimmune Sialadenitis and Benign Lymphoepithelial Lesions19,20
Diagnostic Difficulties
NEOPLASM
Benign
Pleomorphic Adenoma21–23
Diagnostic Difficulties
Warthin's Tumor24
Diagnostic Difficulties
Basal Cell Adenoma (BCA)25
Diagnostic Difficulties
Oncocytoma26
Diagnostic Difficulties
Myoepithelial Tumors27–29
Diagnostic Difficulties
MALIGNANT TUMORS
Adenoid Cystic Carcinoma (ACC)30–33
Diagnostic Difficulties
Acinic Cell Carcinoma34,35
Diagnostic Difficulties
Mucoepidermoid Carcinoma36
Diagnostic Difficulties
Polymorphous Low Grade Adenocarcinoma (PLGA)37
Diagnostic Difficulties
Other Tumors
Metastatic Malignancy38
Approach to Salivary Gland Lesions
ORBITAL LESIONS
Eyelid
Neoplasms
Retinoblastoma46
Diagnostic Difficulty
Malignant Melanoma
Lymphomas47
Optic Glioma (Figures 2.20A and B)
Rhabdomyosarcoma
Metastatic Malignancy48
Granulocytic Sarcoma
CHAPTER 3:
Thyroid
APPROACH TO FNAC OF THE THYROID
Clinical History and Physical Examination
Other Investigations
TECHNIQUES
OPTIMAL MATERIAL
NORMAL ASPIRATED MATERIAL
TERMINOLOGY
LESIONS
NODULAR COLLOID GOITER
Diagnostic Difficulties
ADENOMATOID NODULE/ HYPERPLASTIC NODULE
Diagnostic Difficulties
DIFFUSE TOXIC GOITER
THYROIDITIS
Acute Thyroiditis
Diagnostic Difficulties
SUBACUTE GRANULOMATOUS THYROIDITIS
Diagnostic Difficulties
CHRONIC LYMPHOCYTIC THYROIDITIS
Diagnostic Difficulties
FOLLICULAR NEOPLASM
Diagnostic Difficulties
HURTHLE CELL NEOPLASM
Diagnostic Difficulties
PAPILLARY CARCINOMA
VARIANTS OF PAPILLARY CARCINOMA OF THYROID
Diagnostic Difficulties of Usual PC
VARIANTS OF PAPILLARY CARCINOMAS: DIAGNOSTIC DIFFICULTIES
MEDULLARY CARCINOMA (MC)
IMMUNOCYTOCHEMISTRY
Diagnostic Difficulties
ANAPLASTIC CARCINOMA
Diagnostic Difficulties
INSULAR CARCINOMA
Diagnostic Difficulties
LYMPHOMAS32–35
Diagnostic Difficulties
METASTATIC MALIGNANT TUMORS
Diagnostic Difficulties
ANCILLARY TECHNIQUES
CHAPTER 4:
Breast
INDICATIONS OF FNAC OF BREAST
DIAGNOSTIC ACCURACY
OVERALL APPROACH
CLINICAL HISTORY
Mammography
TRIPLE TEST
CORE NEEDLE BIOPSY VERSUS FNAC
Fine Needle Aspiration Techniques
IS THIS SAMPLE ADEQUATE?
NORMAL BREAST FNAC
APPROACH TO FNAC OF BREAST LESIONS
INFLAMMATORY LESIONS
Acute Inflammation
Granulomatous Mastitis (Figure 4.2)
Tuberculous Mastitis
Fat Necrosis
BENIGN LESIONS
Fibroadenoma
Diagnostic Difficulties
FIBROCYSTIC DISEASE
Diagnostic Difficulties
GALACTOCELE
LACTATING ADENOMA
Diagnostic Difficulty
PROLIFERATIVE BREAST DISEASE WITH ATYPIA
Diagnostic Difficulties
DUCTAL CARCINOMA IN SITU16
Diagnostic Difficulty
PHYLLODES TUMOR22
Diagnostic Difficulties
PAPILLARY LESIONS OF THE BREAST
Diagnostic Difficulties
CARCINOMA
Diagnostic Difficulties
OTHER TYPES
Medullary Carcinoma
Diagnostic Difficulties
MUCINOUS CARCINOMA (COLLOID CARCINOMA)26
Diagnostic Difficulties
APOCRINE CARCINOMA
Diagnostic Difficulties
TUBULAR CARCINOMA
Diagnostic Difficulties
METAPLASTIC CARCINOMA (FIGURE 4.15)
LOBULAR CARCINOMA28
Diagnostic Difficulties
PAGET'S DISEASE
DIAGNOSTIC CHALLENGES
OTHER UNCOMMON MALIGNANCIES
MALE BREAST LESIONS
Diagnostic Difficulties
CARCINOMA IN MALE BREAST
ANCILLARY INVESTIGATIONS ON BREAST ASPIRATION MATERIAL
Immunocytochemistry
REPORTING OF BREAST FNAC
Cytological Grade
DIAGNOSTIC PITFALLS IN BREAST FNAC
CHAPTER 5:
Lung
NORMAL AND BENIGN CELLS (FIGURES 5.1A AND B)
INFLAMMATORY LESIONS
Acute Inflammation
Diagnostic Difficulties
SPECIFIC INFECTIONS (FIGURES 5.2A TO D)
GRANULOMATOUS INFLAMMATION
Diagnostic Difficulties
LUNG CARCINOMAS5–11
SQUAMOUS CELL CARCINOMA
Diagnostic Difficulties
BRONCHOGENIC ADENOCARCINOMA
Diagnostic Difficulties
BRONCHIOLOALVEOLAR CARCINOMA (BAC)
Diagnostic Difficulties
SMALL CELL CARCINOMA
Immunocytochemistry
Diagnostic Difficulties
UNDIFFERENTIATED LARGE CELL CARCINOMA
Diagnostic Difficulties
CARCINOID
Diagnostic Difficulties
PULMONARY BLASTOMA12,13
Diagnostic Difficulties
METASTATIC MALIGNANCIES (FIGURES 5.11A TO C)
PLEURA
Mesothelioma14,15
Immunocytochemistry
Diagnostic Difficulties
CHAPTER 6:
Mediastinum
CLINICAL HISTORY
RADIOLOGICAL LOCALIZATION
TECHNIQUES
LESIONS
Thymoma9–11
Diagnostic Difficulties
MALIGNANT THYMOMA12–14
Diagnostic Difficulties
THYMIC CARCINOID
ATYPICAL CARCINOID
Diagnostic Difficulty
GERM CELL TUMORS15,16
MATURE CYSTIC TERATOMA
Diagnostic Difficulties
IMMATURE TERATOMA
GERMINOMAS
Diagnostic Difficulty
EMBRYONAL CARCINOMA
Diagnostic Difficulty
ENDODERMAL SINUS TUMOR
LYMPHOMAS17–19
Non-Hodgkin's Lymphoma (NHL)
Large Cell NHL
Diagnostic Difficulty
LYMPHOBLASTIC LYMPHOMA
Diagnostic Difficulty
HODGKIN'S LYMPHOMA
Diagnostic Difficulty
NEUROGENIC TUMOR20,21
NEUROBLASTOMA
Diagnostic Difficulty
GANGLIONEUROBLASTOMA
PERIPHERAL NERVE SHEATH TUMOR
Neurofibroma and Schwannoma
MALIGNANT PERIPHERAL NERVE SHEATH TUMORS (FIGURE 6.9)
Diagnostic Difficulties
PARAGANGLIOMA
METASTATIC CARCINOMA(FIGURES 6.10A TO C)
APPROACH TO THE DIAGNOSIS OF MEDIASTINAL TUMORS
CHAPTER 7:
Lymph Node
APPROACH
Clinical History
PHYSICAL FINDINGS
ASPIRATION
NORMAL COMPONENT OF A LYMPH NODE (BOX 7.2.)
FOLLICULAR CENTER CELLS (FIGURE 7.1)
REACTIVE LYMPHOID HYPERPLASIA
Diagnostic Difficulties
ACUTE LYMPHADENITIS
CYTOLOGY
GRANULOMATOUS LYMPHADENITIS5,6
Diagnostic Difficulties
ROSAI-DORFMAN DISEASE7–9
Diagnostic Difficulties
KIMURA'S DISEASE10
Diagnostic Difficulties
KIKUCHI'S DISEASE11
Diagnostic Difficulties
HIV LYMPHADENOPATHY12–14
LANGERHANS CELL HISTIOCYTOSIS (LCH)15,16
Diagnostic Difficulties
DERMATOPATHIC LYMPHADENITIS
Diagnostic Difficulties
METASTATIC MALIGNANT TUMOR17–20
Diagnostic Difficulties
LYMPHOMAS
LYMPHOMA CLASSIFICATION
B CELL SMALL LYMPHOCYTIC LYMPHOMA (SLL)
MANTLE CELL LYMPHOMA (MCL)
FOLLICULAR CENTER CELL (FCC) LYMPHOMA (BOX 7.15)
MARGINAL ZONE LYMPHOMA
DIFFUSE LARGE B CELL LYMPHOMA
CENTROBLASTIC
IMMUNOBLASTIC
T CELL/HISTIOCYTES RICH (FIGURES 7.15A TO C)
ANAPLASTIC
B LYMPHOBLASTIC LYMPHOMA
BURKITT LYMPHOMA
T CELL CHRONIC LYMPHOCYTIC LYMPHOMA
T LYMPHOBLASTIC LYMPHOMA
ANAPLASTIC LARGE CELL LYMPHOMA (ALCL)
HODGKIN'S LYMPHOMA (HL)33,34
Diagnostic Difficulties
LEUKEMIC INFILTRATION (FIGURES 7.20A AND B)
Diagnostic Difficulty
CHAPTER 8:
Liver, Spleen, Pancreas and Gastrointestinal Tract
LIVER
Normal Cells
LIVER LESIONS
NON-NEOPLASTIC LESIONS
Cysts
BENIGN NEOPLASTIC LESION
Liver Cell Adenomas
Diagnostic Difficulties
MALIGNANT TUMORS
Hepatocellular Carcinoma (HCC)1–9
FIBROLAMELLAR VARIANT OF HCC
CLEAR CELL VARIANT
GIANT CELL VARIANT OF HCC
SMALL CELL VARIANT
SPINDLE CELL VARIANT
Diagnostic Difficulties
CHOLANGIOCARCINOMA
Diagnostic Difficulties
HEPATOBLASTOMA10–13
Diagnostic Difficulties
METASTATIC MALIGNANCIES
Diagnostic Difficulties
SPLEEN
NON-NEOPLASTIC PROCESS
Granulomatous Infection
STORAGE DISORDERS
NEOPLASM
Lymphoma
PANCREAS
Normal Cells
LESIONS
Cystic Lesions of Pancreas
Pancreatic Cystadenoma
Mucinous Neoplasia19,20
PANCREATIC PSEUDOCYST
CARCINOMA
Ductal Adenocarcinoma16,17,21–23
Diagnostic Difficulties
OTHER TYPES OF CARCINOMA
PANCREATIC ACINAR CARCINOMA24(FIGURE 8.11)
NEUROENDOCRINE TUMOR
Islet Cell Tumor of Pancreas25–27
Diagnostic Difficulties
SOLID AND CYSTIC PAPILLARY NEOPLASM (SCPN) OF PANCREAS28–30
Diagnostic Difficulties
GASTROINTESTINAL TUMORS
Adenocarcinoma
SIGNET RING CELL ADENOCARCINOMA
CARCINOID TUMORS OF THE SMALL INTESTINE31,32
Diagnostic Difficulties
GASTROINTESTINAL STROMAL TUMOR (GIST)33,34
Diagnostic Difficulties
PRIMARY SMALL INTESTINAL LYMPHOMAS
CHAPTER 9:
Kidney and Adrenal
NORMAL CELLS
RENAL LESIONS
Diagnostic Difficulty
Xanthogranulomatous Inflammation
Diagnostic Difficulty
Angiomyolipoma6,7
Diagnostic Difficulty
Renal Cell Carcinoma (RCC)1,3,4,8–10
Diagnostic Difficulties
The Other Variants of RCC (Table 9.4)
Diagnostic Difficulties
Oncocytoma
Diagnostic Difficulties
Transitional Cell Carcinoma (TCC)
Diagnostic Difficulties
PEDIATRIC RENAL TUMORS
Wilms’ Tumor11,12
Diagnostic Difficulties
Mesoblastic Nephroma13
Diagnostic Difficulty
RHABDOID TUMOR
Diagnostic Difficulty
Clear Cell Sarcoma14
Adrenal
LESIONS
Adrenocortical Carcinoma19–22
Diagnostic Difficulties
Pheochromocytoma23
Diagnostic Difficulties
Metastatic Tumors24
CHAPTER 10:
Gonads and Prostate
TESTIS
PERITESTICULAR LESIONS
Hydrocele
Spermatocele (Figure 10.1)
INFLAMMATION
SPERMATOCYTIC GRANULOMA1 (FIGURES 10.2A AND B)
Other Tumors
NEOPLASMS OF TESTIS
Seminoma2–6
Diagnostic Difficulties
Embryonal Carcinoma
Yolk Sac Tumor
Choriocarcinoma
OTHER TUMORS OF TESTIS
EVALUATION OF MALE INFERTILITY7–10 (FIGURES 10.7A AND B)
FEMALE GENITAL SYSTEM
OVARIAN TUMOR11–15
Serous and Mucinous Adenocarcinoma (Figures 10.8A and B)
Diagnostic Difficulties
CLEAR CELL CARCINOMA (FIGURES 10.9A AND B)
Diagnostic Difficulties
GERM CELL TUMOR
IMMATURE TERATOMA (FIGURES 10.10A AND B)
GRANULOSA CELL TUMOR (FIGURES 10.11A TO C)
PROSTATE16–17
BENIGN PROSTATIC HYPERPLASIA
CARCINOMA
Diagnostic Difficulties
CHAPTER 11:
Soft Tissue Lesions and Skin
DIFFERENT LESIONS
Lipoma and its variants8,9
Diagnostic difficulty
Fibromatosis
Diagnostic Difficulty
Nodular fasciitis
Diagnostic Difficulty
Benign peripheral nerve sheath tumor10
Diagnostic Difficulty
Myositis ossificans11,12
Diagnostic Difficulty
Giant cell tumor of tendon sheath13–15
MALIGNANT TUMOR
Liposarcomas16–19
Well-differentiated liposarcoma
Myxoid liposarcoma
Pleomorphic liposarcoma
Round cell liposarcoma
Diagnostic Difficulties
Malignant peripheral nerve sheath tumor (MPNST)20
Diagnostic Difficulty
Fibrosarcoma21
Diagnostic Difficulty
Malignant fibrous histiocytoma (Figures 11.10A and B)
Storiform pleomorphic MFH
Myxoid MFH
Giant cell MFH
Dermatofibrosarcoma protuberans
Synovial sarcoma1,3,4
Cytology (Figures 11.11A and B)
Biphasic
Monophasic synovial cell sarcoma
Diagnostic Difficulty
Rhabdomyosarcoma22–24 (Figures 11.12a and b)
Alveolar rhabdomyosarcoma
Embryonal rhabdomyosarcoma
Diagnostic Difficulties
Leiomyosarcomas25
Diagnostic Difficulty
Clear Cell Sarcoma26
Diagnostic Difficulties
Epithelioid sarcomas27–30
Diagnostic Difficulties
Alveolar soft part sarcomas31
Hemangiopericytoma
SKIN
Inflammation
Diagnostic Difficulty
Pilomatrixoma36
Diagnostic Difficulty
Basal cell carcinoma37,38
Granular cell tumor
Meibomian carcinoma39,40
Diagnostic Difficulties
Malignant melanoma34,41,42
Diagnostic Difficulties
Malignant sweat gland tumor43,44
Markel Cell Tumor45,46
Diagnostic Difficulty
Metastasis47,48
Diagnostic Difficulties
Miscellaneous
CHAPTER 12:
Bone
NORMAL CELLS
OSTEOSARCOMA8–10
Diagnostic Difficulties
CHONDROSARCOMA11–13
Diagnostic Difficulty
GIANT CELL TUMOR OF BONE (GCT)14–16
Diagnostic Difficulty
CHONDROBLASTOMA
Diagnostic Difficulty
CHORDOMA17,18
Diagnostic Difficulties
EWING'S SARCOMA19–21
Diagnostic Difficulty
NON-HODGKIN'S LYMPHOMA
METASTATIC CARCINOMA
PLASMA CELL NEOPLASM22–24
Diagnostic Difficulty
LANGERHANS CELL HISTIOCYTOSIS25,26
Diagnostic Difficulty
CHAPTER 13:
Round Cell Tumor
FINE NEEDLE ASPIRATION
CYTOMORPHOLOGY
NEUROBLASTOMA
EWING'S SARCOMA (EWS) AND PERIPHERAL NEUROECTODERMAL TUMOR (PNET)
WILMS' TUMOR (WT) (FIGURE 13.3)
RHABDOMYOSARCOMA (RMS)
DESMOPLASTIC SMALL ROUND CELL TUMOR (DSRCT)3
INDEX
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