DeutschesFachbuch.de : Fine Needle Aspiration Cytology Diagnostic Principles and Dilemmas Von Gabrijela Kocjan

Contents

Preface			VII

Contents			IX

Introduction and Historical Perspective			1

References			3

FNAC Technique and Slide Preparation			7

2.1	Informed Consent		7

2.2	Location of the FNAC Procedure		8
	2.2.1	The FNAC Clinic	9
	2.2.2	Inpatient FNAC	12
	2.2.3	Image-Guided and Other FNAC Procedure Locations	12

2.3	The Importance of the Aspirator		14

2.4	Aspiration Techniques		15
	2.4.1	Suction FNAC	15
	2.4.2	The Capillary Method	16

2.5	Slide Preparation		17
	2.5.1	Conventional Preparations	17
	2.5.2	Liquid-Based Preparations	18
	2.5.3	Cell Block	18

2.6	Fixation Techniques		19
	2.6.1	Air Drying	19
	2.6.2.	Alcohol Fixation	20
	2.6.3	Transport Medium	20

2.7	Staining Methods		20
	2.7.1	Papanicolaou Staining	20
	2.7.2	Romanowsky Staining	22
	2.7.3	Other Stains	23

2.8	Ancillary Techniques		23
	2.8.1	Cytochemistry	23
	2.8.2	Immunocytochemistry	24
	2.8.3	Molecular Markers in Cytology	26

2.9	Safety		27

References			28

Diagnostic interpretation of FNAC material			35

3.1	Slide Background		35
	3.1.1	Cystic Background	39
	3.1.2	Inflammatory Background	40
	3.1.3	Necrotic Background	42
	3.1.4	Myxoid and Mucinous Background	42
	3.1.5	Lymphoid Background	43
	3.1.6	Other Background Features	43

3.2	Cell Arrangement		44
	3.2.1	Clusters	46
	3.2.2	Sheets	46
	3.2.3	Single Cells	47
	3.2.4	Papillary Arrangement	47
	3.2.5	Other Features	48

3.3	Cellular Features: the Nucleus		49
	3.3.1	Nuclear Size	50
	3.3.2	Nuclear Shape	51
	3.3.3	Position of the Nucleus	52
	3.3.4	Chromatin Pattern	53
	3.3.5	Number of Nuclei	54
	3.3.6	Nucleoli	54
	3.3.7	Mitoses	55

3.4	Cellular Features: Cytoplasm		55
	3.4.1	Relative Amount	55
	3.4.2	Quality and Contents	55
	3.4.3	Shape and Definition	56

3.5	Criteria of Malignancy		57

3.6	Cytology Report		57

References			58

Diagnostic Dilemmas in FNAC Practice: Cystic Lesions			59

4.1	Cysts in the Neck		59
	4.1.1	Thyroglossal Duct Carcinoma	60
	4.1.2	Branchial Cleft Cysts	61
	4.1.3	Salivary Gland Lesions	62
	4.1.4	Lymphoepithelial Cysts	63
	4.1.5	Cystadenolymphoma	64
	4.1.6	Acinic Cell Carcinoma	66
	4.1.7	Pleomorphic Adenoma	67
	4.1.8	Dermoid Cyst	68
	4.1.9	Thyroid Cysts	68
	4.1.10	The Lymph Nodes	70
	4.1.11	Parathyroid Cysts	71
	4.1.12	Cysts of the Jaw	72
	4.1.13	Teratoid Cyst	72

4.2	Cysts in the Abdomen		73
	4.2.1	Cystic Lesions of the Pancreas	73
	4.2.2	Cystic Lesions of the Liver	77
	4.2.3	Adrenal and Renal Cystic Lesions	78
	4.2.4	Cystic Lesions of the Peritoneum	79

4.3	Thoracic Cysts		79

4.4	Breast Cysts		80

4.5	Other Cysts and Artefacts		82

References			85

Diagnostic Dilemmas in FNAC Practice: Lymphoid Infiltrates			91

5.1	Granulomatous Infiltrates		91
	5.1.1	Tuberculous Lymphadenitis	91
	5.1.2	Sarcoidosis	92
	5.1.3	Kikuchi-Fujimoto Disease	92
	5.1.4	Cat-Scratch Disease	94
	5.1.5	Leishmania Lymphadenitis	94
	5.1.6	Kimura's disease	95
	5.1.7	Sinus Histiocytosis with Massive Lymphadenopathy	96
	5.1.8	Foreign-Body Granulomatous Inflammatory Response	96
	5.1.9	Malignant Lymphomas	97

5.2	Lymphoid Infiltrates in Extranodal Sites		99
	5.2.1	Lymphoid Infiltrates in the Thyroid	99
	5.2.2	Lymphoid Processes in the Salivary Gland	103
	5.2.3	Lymphoid Infiltrates of the Orbit	105
	5.2.4	Lymphoid Lesions in the Breast	107

5.3	Neoplasms Containing Lymphocytes		107
	5.3.1	Dilemmas in the Cytological Diagnosis of Lymphomas	108
	5.3.2	Solid Neoplasms Containing Lymphocytes	109

References			110

Diagnostic Dilemmas in FNAC Practice: Metastatic Tumours			117

6.1	Metastatic Carcinomas		118
	6.1.1	Establishing the Diagnosis of Malignancy	118
	6.1.2	Determining the Nature of the Tumour	120
	6.1.3	Finding the Primary Tumour	124
	6.1.4	The Role of Imaging in the FNAC of Metastases	129

6.2	Metastases of Non-Epithelial Tumours		129

References			130

Diagnostic Dilemmas in FNAC Cytology: Small Round Cell Tumours			133

7.1	Small Round Cell Tumours of Childhood		133
	7.1.1	Ewing's Sarcoma/Primitive Neuroectodermal Tumour	134
	7.1.2	Neuroblastoma	136
	7.1.3	Ganglioneuroblastomas	136
	7.1.4	Rhabdomyosarcoma	137
	7.1.5	Acute Lymphoblastic Leukaemia and LBL	139
	7.1.6	Small Round Cell Tumours of Kidney	141
	7.1.7	Hepatoblastoma	141
	7.1.8	Pleuropulmonary Blastoma	142
	7.1.9	Small-Cell Synovial Sarcoma	142

7.2	Small Round Cell Tumours in Adults		142
	7.2.1	Desmoplastic Small Round Cell Tumour	143
	7.2.2	Small-Cell Carcinoma of the Lung	144
	7.2.3	Burkitt's Lymphoma	144
	7.2.4	Lymphoglandular Bodies	145
	7.2.5	Merkel Cell Carcinoma	146
	7.2.6	Olfactory Neuroblastoma	147

References			148

Diagnostic Dilemmas in FNAC Cytology: Soft-Tissue Lesions			151

8.1	Introduction		151

8.2	Spindle-Cell Lesions		153
	8.2.1	Spindle-Cell Lesions of the Lung	156
	8.2.2	Spindle-Cell Lesions of the Salivary Gland	156
	8.2.3	Spindle-Cell Lesions of the Breast	157
	8.2.4	Myofibrosarcoma	157

8.3	Myxoid and Chondroid Lesions		157
	8.3.1	Low-Grade Fibromyxoid Sarcoma	159
	8.3.2	Leiomyosarcoma	160
	8.3.3	Ossifying Fibromyxoid Tumour	161
	8.3.4	Myxoid Mucinous Neoplasms	161
	8.3.5	Intramuscular Myxoma	162
	8.3.6	Chondrosarcoma	162
	8.3.7	Chondroblastoma	162

8.4	Pseudosarcomatous Lesions		162
	8.4.1	Nodular Fasciitis	165
	8.4.2	Nodular Myositis	165
	8.4.3	Proliferative Fasciitis and Myositis	165
	8.4.4	Fibromatoses	166
	8.4.5	Fibrous histiocytoma	167
	8.4.6	Pseudoangiomatous Stromal Hyperplasia	167
	8.4.7	Pleomorphic Lipoma	168
	8.4.8	Atypical Lipoma	168
	8.4.9	Spindle-Cell Lipoma	169
	8.4.10	Ancient Schwannoma	169
	8.4.11	Angioleiomyoma	169
	8.4.12	Calcifying Aponeurotic Fibroma	169
	8.4.13	Lipomatous Haemangiopericytoma	169

8.5	Tumours of Low or Borderline Malignancy		169
	8.5.1	Dermatofibrosarcoma Protuberans	170
	8.5.2	Haemangiopericytoma	170
	8.5.3	Acral Myxoinflammatory Fibroblastic Sarcoma	171

8.6	Soft-Tissue Deposits of Non-Sarcomatous Lesions		171
	8.6.1	Malignant Lymphoma and Leukaemia	171
	8.6.2	Calcinosis Cutis	171

8.7	Sarcomas Mimicking Other Lesions		171
	8.7.1	Epithelioid Sarcoma	171
	8.7.2	Metastatic Soft-Tissue Sarcomas	172
	8.7.3	Well-Differentiated Liposarcoma	172

8.8	Rare and Difficult Sarcomas		172
	8.8.1	Alveolar Soft-Part Sarcoma	172
	8.8.2	Angiosarcoma	172
	8.8.3	Kaposi's Sarcoma	174
	8.8.4	Clear-Cell Sarcoma of Soft Parts	175
	8.8.5	Haemangioendothelioma	175
	8.8.6	Giant-Cell Fibroblastoma	175
	8.8.7	Rhabdomyosarcoma	175
	8.8.8	Synovial Sarcoma	176

References			177

Diagnostic Dilemmas in FNAC Cytology: Difficult Breast Lesions			181

9.1	Fibroadenoma		182

9.2	Papillary Lesions		188

9.3	Apocrine Changes		193

9.4	Mucinous Lesions		195

9.5	Lobular Carcinoma		196

9.6	In Situ or Invasive Carcinoma?		198

9.7	Rare Lesions		202
	9.7.1	Radial Scar/Complex Sclerosing Lesion	202
	9.7.2	Collagenous Spherulosis	203
	9.7.3	Ductal Adenoma	203
	9.7.4	Gynaecomastia	203
	9.7.5	Spindle-Cell and Mesenchymal Lesions of the Breast	204
	9.7.6	Pseudoangiomatous Stromal Hyperplasia	205
	9.7.7	Metaplastic Tumours	205
	9.7.8	Secretory Carcinoma	205
	9.7.9	Tumoral Calcinosis	205
	9.7.10	Clear-Cell Hidradenoma	206
	9.7.11	Tubular Adenoma	206
	9.7.12	Adenomyoepithelioma	206
	9.7.13	Squamous Cells	206
	9.7.14	Inflammatory Myofibroblastic Tumour	207

9.8	FNAC or core biopsy?		207

9.9	Radiation Changes		207

References			207

Principles of Safe Practice: the Role of FNAC in Clinical Management			213

10.1	FNAC Breast Lesions		214

10.2	FNAC Thyroid		215

10.3	FNAC Head and Neck Conditions		216

10.4	FNAC Lymph Nodes		216

10.5	FNAC Adrenal and Kidney		217

10.6	FNAC Gastrointestinal Tract		217

10.7	FNAC Soft Tissue		218

10.8	FNAC Bone		218

10.9	FNAC in Children		218

10.10	FNAC for HIV-Related Lesions		219

10.11	Transrectal Digitally Guided FNAC		219

10.12	FNAC in Gynaecology		219

10.13	Diagnostic Accuracy and Cost-Effectiveness of FNAC		219

References			220

Principles of Safe FNAC Practice: FNAC versus Core Biopsy			225

11.1	Breast Lesions		225

11.2	Lung Lesions		227

11.3	Hepatic Lesions		227

11.4	Abdominal Lesions		227

11.5	Prostate Cancer		228

11.6	Thyroid Lesions		228

11.7	Gynaecological Lesions		228

11.8	Soft-Tissue Lesions		228

11.9	Skeletal Lesions		228

11.10	Summary		229

References			229

Principles of Safe FNAC Practice: Medicolegal Issues			231

References			235

Subject Index			237