Fine Needle Aspiration Cytology: Interpretation and Diagnostic Difficulties Pranab Dey
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1FINE NEEDLE ASPIRATION CYTOLOGY Interpretation and diagnostic difficulties2
second Edition
3FINE NEEDLE ASPIRATION CYTOLOGY Interpretation and diagnostic difficulties
Pranab Dey MBBS MD MIAC FRCPATH Professor Department of Cytology Post Graduate Institute of Medical Education and Research Chandigarh, India
4
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Fine Needle Aspiration Cytology: Interpretation and Diagnostic Difficulties
First Edition: 2012
Second Edition: 2015
9789351526087
Printed at
5 Dedicated to
Shree Shree Satyananda Giri & Rini and Madhumanti 6
7 Preface to the Second Edition
In this second edition of the book, I have completely reoriented the different chapters. The various diagnostic entities have been discussed in detail with the etiology, histology, cytology, immunocytochemistry and molecular genetics. The differential diagnoses of the lesions have been described in detail with multiple tables. I have added eight more chapters with a large number of new microphotographs. The history of fine needle aspiration cytology (FNAC), deep seated guided FNAC, ancillary techniques, cytology of central nervous system and a case review sections have been added. In the review section, I have emphasized the interesting and a few classical cases.
I hope that this second edition of the book will act as a complete textbook of fine needle aspiration cytology that will help both the practicing cytologists and the pathology residents.
Pranab Dey 8
9 Preface to the First Edition
Fine needle aspiration cytology (FNAC) is now a well-recognized technique in diagnosis of various lesions. Increasing numbers of pathologists are now practicing cytology. Aspiration cytology is also included in the curriculum of the postgraduate training in pathology. Therefore, it is extremely necessary to know the various aspects of fine needle aspiration cytology.
In this book, Fine Needle Aspiration Cytology: Interpretation and Diagnostic Difficulties, I have discussed the important diagnostic features of aspiration cytology with multiple illustrations. The diagnostic problems of various lesions have been discussed in detail. I have mainly concentrated on the cytomorphology. However, the immunocytochemistry and other ancillary techniques have also been discussed. I hope that this book will help both the practicing cytologists and the pathology residents.
Pranab Dey 10
11 Acknowledgments
I am thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and Mr Tarun Duneja (Director–Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving me the opportunity and encouragement in publishing this book. My particular thanks to Shri Jitendar P Vij for his continuous support.
I wish to express my special and heartiest thanks to Late Professor Subhash Kumari Gupta and Professor Arvind Rajwanshi, who are my great teachers in the field of cytology. I am also thankful to my departmental colleagues Dr Raje Nijhawan, Dr Radhika and Dr Nalini, for day-to-day routine cooperation.
My students were the initial stimulation for writing this book. I am thankful to them. I am proud to work in the Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. The excellent set up of this institution helped me a lot.
I wish to express my gratitude to Dr Uma Nahar Saikia, Dr Nandita Kakkar, Dr BD Radotra and Dr Anupam Lal. They gave me full support and provided multiple photographs of different cases.
I wish to express my special and sincere thanks to my two junior friends Dr Debajyoti Chatterjee and Dr Suvradeep Mitra, who helped me in every possible ways. They were always beside me and I discussed many things with Dr Suvradeep during preparation of the manuscript. I am also thankful to Dr Debasis Gochhait and Dr Arghya Banerjee, for their valuable suggestions.
I wish to give major credits of the book to my wife Rini who helped me from beginning to the end. She encouraged me and provided valuable suggestions during preparation of the manuscript.
Lastly, I express my deep gratitude to the Supreme power, without His blessings nothing can be done.
Abbreviations
Abbreviation
Full form
AIDS
Acquired immunodeficiency syndrome
PLAP
Placental alkaline phosphatase
ABC
Aneurysmal bone cyst
AC
Atypical carcinoid
ACC
Acinic cell carcinoma
ACCa
Adrenocortical carcinoma
ADCC
Adenoid cystic carcinoma
ADH
Atypical ductal hyperplasia
AFP
Alpha fetoprotein
ALCL
Anaplastic large cell lymphoma
ALK
Anaplastic lymphoma kinase
ALT
Atypical lipomatous tumor
AML
Angiomyolipoma
AR
Androgen receptor
ABC
Aneurysmal bone cyst
ASPS
Alveolar soft part sarcoma
BAC
Bronchioloalveolar carcinoma
BAL
Bronchioalveolar lavage
BCA
Basal cell adenomas
BCC
Basal cell carcinoma
BIRADS
Breast imaging reporting and data system
BL
Burkitt lymphoma
B-SQC
Basaloid SQC
Ca Ex PA
Carcinoma ex-pleomorphic adenoma
c-ANCA
Cytoplasmic antinuclear cytoplasmic antibody
CAP
College of American Pathologists
CASTLE
Carcinoma showing thymus like differentiation
CCS
Clear cell sarcoma
CCSK
Clear cell sarcoma of kidney
CEA
Carcinoembryonic antigen
CGH
Comparative genomic hybridization
CHS
Chondrosarcoma
CK
Cytokeratin
CL
Carbon localization
CLL
chronic lymphocytic leukemia
CML
Chronic myeloid leukemia
CMN
Congenital mesoblastic nephroma
CNB
Core needle biopsy
CNS
Central nervous system
CP
Cytosarcoma phylloides
CT
Computed tomography
DCIS
Ductal carcinoma in situ
DCP
Des-gamma-carboxy prothrombin
DFSP
Dermatofibrosarcoma protuberans
DIN
Ductal intraepithelial neoplasia
DLBCL
Diffuse large B cell lymphoma
DSRCT
Desmoplastic small round cell tumor
EA
Eosin Azure
EBV
Epstein-Barr virus
EC
Embryonal carcinoma
EGFR
Epithelial growth factor receptor
EM
Electron microscopy
EMA
Epithelial membrane antigen
EMH
Extramedullary hematopoiesis
ER
Estrogen receptor
ERCP
Endoscopic retrograde cholangiopancreatography
ES
Epithelioid sarcoma
ESS
Endometrial stromal sarcoma
EST
Endodermal sinus tumor
EUS
Endoscopic guided ultrasound
EUS-FNA
Endoscopic ultrasound-guided FNA
EWS
Ewing’s sarcoma
FAd
Fibroadenoma
Fca
Follicular carcinoma
FCI
Flow cytometric immunophenotyping
FCM
Flow cytometry
FD
Fibrocystic disease
FDCS
Follicular dendritic cell sarcoma
FISH
Fluorescent in situ hybridization
FL
Follicular lymphoma
FN
Follicular neoplasm
FNAC
Fine needle aspiration cytology
FNCLCC
Fédération Nationale des Centers de Lutte Contré le Cancer
FNH
Focal nodular hyperplasia
FNS
Fine needle sampling
FVPCT
Follicular variant of papillary carcinoma
GBM
Glioblastoma multiforme
GCB
Germinal center B-cell
GCT
Giant cell tumor of bone
GCTTS
Giant cell tumor of tendon sheath
GFAP
Glial fibrillary acidic protein
GIST
Gastrointestinal stromal tumors
GIT
Gastrointestinal tract
GLUT-4
Glucose transporter 4
GM
Granulomatous mastitis
H & E
Hematoxylin and eosin
HCC
Hepatocellular carcinoma
hCG
Human chorionic gonadotropin
Hep Par1
Human hepatocyte antibody
HL
Hodgkin lymphoma
HP
High power
HSTCL
Hepatosplenic T-cell lymphoma
IC
Immunocytochemistry
ICa
Insular carcinoma
ICC
Intrahepatic cholangiocarcinoma
IDC
Infiltrating duct carcinoma
IDC, NOS
Infiltrating ductal carcinoma, not otherwise specified
ILC
Invasive lobular carcinoma
IM
Intramuscular myxoma
LBC
Liquid-based cytology
LBL
Lymphoblastic lymphoma
LCA
Leukocyte common antigen
LCC
Large cell carcinoma
LCH
Langerhans cell histiocytosis
LESA
Lymphoepithelial sialadenitis
LG
Lymphoglandular bodies
LJ
Löwenstein-Jensen
LP
Low power
LPL
Lymphoplasmacytic lymphoma
LPS
Liposarcomas
LS
Leiomyosarcomas
LT
Lymphocytic thyroiditis
MA
Metanephric adenoma
MAI
Mycobacterium avium intercellulare
MALTOMA
Mucosa-associated lymphoma
MC
Medullary carcinoma
MCL
Mantle cell lymphoma
MCN
Mucinous cystic neoplasia
MDR
Multidrug resistant
MEC
Mucoepidermoid carcinoma
MEN
Multiple endocrine neoplasia
MFH
Malignant fibrous histiocytoma
MFH
Malignant fibrous histiocytoma
MGG
May Grunwald Giemsa
MLS
Myxoid liposarcoma
MNG
Multinodular goiter
MNGC
Multinucleated giant cells
MO
Myositis ossificans
MP
Medium power
MPNST
Malignant peripheral nerve sheath tumor
MRI
Magnetic resonance imaging
MTBC
M. tuberculosis complex
MZL
Marginal zone lymphoma
N/C
Nucleocytoplasmic ratio
NB
Neuroblastoma
NB 84
Neuroblastoma-84
NCI
National Cancer Institute
NHL
Non-Hodgkin lymphoma
NLPHL
Nodular lymphocyte predominant hodgkin lymphoma
NOD
Nucleotide-binding oligomerization domain
NPC
Nasopharyngeal carcinoma
NSCC
Nonsmall cell carcinoma
NSE
Neuron-specific enolase
NTM
Nontuberculous mycobacteria
OG
Orange G
OI
Oil immersion
PA
Pleomorphic adenoma
PB
Psammoma bodies
p-CEA
Polyclonal carcinoembryonic antigen
PCM
Plasma cell myeloma
PCR
Polymerase chain reaction
PCT
Papillary carcinoma of thyroid
PGL
Persistent generalized lymphadenopathy
PH
Pulmonary hamartoma
PLAP
Placental alkaline phosphatase
PLGA
Polymorphous low grade adenocarcinoma
PMBL
Primary mediastinal B-cell lymphoma
PNET
Peripheral neuroectodermal tumor
PNET
Primitive neuroectodermal tumors
PR
Progesterone receptor
PSA
Prostate specific antigen
PTCL
Peripheral T cell lymphoma
PTLD
Post-transplant lymphoproliferative disorder
RCC
Renal cell carcinoma
REAL
Revised European American Lymphoma
RLH
Reactive lymphoid hyperplasia
RM
Rhabdomyoma
RMS
Rhabdomyosarcoma
R-S
Reed-Sternberg
RTK
Rhabdoid tumor of kidney
RT-PCR
Reverse transcriptase-polymerase chain reaction
SAGE
Serial analysis of gene expression
SB
Southern blot
SC
Sebaceous carcinoma
SCC
Small cell carcinoma
SCNB
Stereotactically-guided core needle biopsy
SCPN
Solid and cystic papillary neoplasm
SFNA
Stereotactically-guided FNA
SFT
Soft tissue tumors
SHML
Sinus histiocytosis with massive lymphadenopathy
SLL
Small lymphocytic lymphoma
SOFT
Solitary fibrous tumor
SPF
Synthetic phase fraction
SQC
Squamous cell carcinoma
SRCT
Small round cell tumor
SS
Synovial sarcoma
STS
Soft tissue sarcoma
T3
Tri-iodothyronine
T4
Tetraiodothyronine
TBG
Thyroxin binding globulin
TC
Typical carcinoid
TCR
T cell receptor
TKI
Tyrosine kinase inhibitor
TLR
Toll-like receptor
TRH
Thyrotropin-releasing hormone
TSH
Thyroid stimulating hormone
TTF
Thyroid transcription factor
TTNA
Transthoracic needle aspirate
UC
Urothelial carcinoma
UDH
Usual ductal hyperplasia
USG
Ultrasonography
VHL
Von Hippel-Lindau
WG
Wegener’s granulomatosis
WHO
World health organization
WT
Warthin’s tumor
WT-1
Wilms’ tumor gene 1
XI
Xanthogranulomatous inflammation
Z-N
Zeihl-Neelsen