Male patient in his second decade presents with huge thigh mass.
Touch preparations stained with Diff Quick showed :
- Fibrillary to myxoid metachromatic stroma.
- The cells show plumpy hyperchromatic nuclei with moderate pleomorphism some intranuclear pseudoinclusions are also noted.
- Nerve sheath differentiation in the form of elongated, slender wavy nuclei.
- Scanty cytoplasm.
On Histopathology the case was diagnosed as Malignant Peripheral Nerve Sheath Tumor.
The morphological features of MPNST are very variable. The 2 most common patterns are the spindle cell and epithelioid cell patterns. Cases showing fibromyxoid like morphology and Hemangiopericytoma like features are reported.
“The majority of MPNST are diagnosed as spindle cell sarcoma or pleomorphic sarcoma with FNA. The cellular features may suggest MPNST but a diagnosis may be difficult, even with the help of adjunctive methods. IC may be of diagnostic help if S-100 protein is positive. The positivity in MPNST is typically focal, extensive staining favours a cellular schwannoma. negative staining with desmin, SMA and muscle-specific actin excludes smooth muscle tumours and negative staining with cytokeratin, EMA and CD99 excludes synovial sarcoma”. The Cytology of Soft Tissue Tumours Dr. Mi1ns Akerman Dr. I-Ienryk A. Domanski
Helpful features include sharp radiating pain in FNA aspiration, Relation with major nerve trunk and history of Neurofibromatosis type 1 .
(By courtesy of Dr. Hatim Khoja)
GCTTS is a very common Benign tumor usually affecting the digits in females ( 2x more common) grossly it is a lobulated small (2-3 Cm.) yellowish mass.
Here in our case we can see :
- osteoclast like gaint cells with many bland looking nuclei.
- many mononuclear cells in the back ground.
- Not much inflammatory cells or hemosidren.
The differential here:
- pigmented villonodualr tenosynovitis – usually in large joints like knee with lots of hemosidren.
- other granulomatous lesions – many inflammatory cells.
- mononuclear cells stain with Desmin
- you may see necrosis , tumor thrombi on paraffin sections.
Neoplastic vs reactive nature is still one of the questions to be solved.
This patient underwent total abdominal hysterectomy and bilateral oopherectomy due to endometrial complex hyperplasia with atypia, the left ovary showed a mass ” couldn’t resist the temptation of taking a smear for fast pap stain” which showed this spindle tumor with fasicular arrangement. the tumor later proved to be a fibrothecoma quit known to screte lots of estrogen that may lead to hyperplastic endometrium. strangly the cells on smears showed many grooves as on sections a feature seen in estrogen secreting granulosa cell tumor.
- The smears are hyper cellular.
- cells appear singly or in loose groups or pseudo rosettes.
- Three types of cell have been described:
- The first type is small to moderate-sized polygonal cells with finely granular cytoplasm and uniform roundor oval nuclei with granular chromatin and prominent chromocenters. These cells are the prototypic cells of neuroendocrine tumors.
- The second type is spindle cells with abundant cytoplasm, elongated nuclei, and coarse granular chromatin.
- large, myoid-like cells with eccentric large nuclei, prominent nucleoli, and abundant pale, finely granular cytoplasm.
The smears may be composed of a mixture of these cell types or one cell type may predominate. “M.BIBO 3rd ed”
Aspirating a pheochromocytoma is dangerous as it may precipitate a hypertensive crisis.
Remember the rule of 10% and multiple endocrine neoplasia association.
Hi there, few days ago i stumbled upon this relatively uncommon renal tumor and misdiagnosed it as Conventional renal cell carcinoma on smears. ” seams i got so much to learn ”
So lets review the Cytological Characteristics of this tumor :
- polygonal cells.
- well defined borders.
- granular to light transparent cytoplasm, clear cells are rare.
- accentuation of the granularity at the periphery of the cell.
- central halo giving the cell koilocyte like appearance.
- the nuclei are eccentric with anisonucleosis.
- some of the nuclei are condensed with raisinoid appearance.
Beware of the Eosinophilic Variant of Chromophobe RCC as it very hard to differentiate from Renal Oncocytoma which is a benign tumor.
-Long slender tapering nuclei sometimes bend and form hooks and comma shapes.
– Fibrillari back ground.
– Watch out from degenerative changes which including pleomorphism.
– If you find verocay bodies you are lucky
This case is dedicated to our dear colleague and friend Ahmed AboSolb, leaving us soon. your case is solved from the very first day 🙂