No single cytologic feature or combination of features distinguished MFH. Patterns ranged from single cells to large storiform fragments. Spindled, plasmacytoid, and pleomorphic cell shapes were found; pleomorphic cells were often multinucleated. All cases of MFH had malignant nuclear morphology. The diagnostic role of FNAB in soft tissue lesions remains controversial.
FNAB is important in the initial triage of patients with soft tissue tumors, and is particularly accurate for confirming recurrent or metastatic disease. Histologic slides of the surgical specimens were stained by routine hematoxylin and eosin.
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All FNAB smears were evaluated for multiple cytologic characteristics Table 1 : cellularity, pattern, presence of fragments and stroma, background blood, necrosis, and inflammation, number of cell types, nuclear features shape, membrane, nuclear:cytoplasmic ratio, chromatin, and nucleoli , cytoplasmic features amount, granularity, presence and quality of vacuoles , and mitoses. Location of the primary tumors included lower extremity 18 , upper extremity 6 , retroperitoneum 3 , head and neck 2 , chest wall 2 , and suprapubic region 1.
Location of recurrences included lower extremity 4 , upper extremity 4 , head and neck 2 , and chest wall 1. Metastases involved lymph nodes 3 and lung 2. Table 2 lists the cytologic diagnoses and corresponding surgical pathology diagnoses. Five were primary tumors, and seven were recurrences or metastases of MFH. Histologic diagnosis and subtyping of MFH was performed according to previously published criteria.
Immunohistochemical stains on paraffin embedded tissue were available for review in only ten cases. Bloody background occurred in 21 aspirates; inflammation was minimal in most cases. Necrosis was observed in only three cases. Tissue fragments varied in size, from small to large. A predominant storiform pattern existed in ten MFH Fig.
A stromal component was absent in 35 aspirates; myxoid stroma was observed in 5, including 2 of the 3 cases of myxoid MFH Fig. There were often two or three different cell types, which included fusiform spindle or round cells, large pleomorphic cells, and multinucleated giant cells MGC Figs. Nuclei in the three cell types displayed malignant characteristics, with anisonucleosis, nucleomegaly increased nuclear:cytoplasmic ratio, notched nuclear membranes, and abnormal chromatin distribution Fig.
Nucleoli were variably present, and were either single or multiple. Cytoplasmic volume depended on cell type, from minimal in spindle cells to abundant in pleomorphic and MGCs, and was either finely granular or coarse. Vacuoles were usually absent; however, when present, they were small and scant.
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Mitotic figures were observed in ten cases, and usually were few in number but bizarre in morphology Fig. Large bizarre tumor giant cells can also be part of the morphologic spectrum of malignant fibrous histiocytoma. Of the two histopathologically diagnosed LMS, one case was a chest wall mass in a patient age 80 years; storiform fragments and spindle cells and MGCs were present. Leiomyosarcoma with single spindle cell population in storiform pattern. Pleomorphic rhabdomyosarcoma was not distinctive from malignant fibrous histiocytoma.
Rare atypical spindled cells with enlarged nuclei were present. Immunostains on cytologic material were not performed.
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Additional cytologic material as cell block or cytopsins was available in only 12 cases. The role of FNAB in the evaluation of soft tissue lesions remains controversial, although the diagnostic accuracy approaches that of other body sites in distinguishing between benign and malignant masses. The utility of this procedure is, of course, dependent on the procurement of an adequate sample. This may be a problem in densely fibrous or vascular lesions, and in certain benign and low grade mesenchymal tumors.
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Very little has been published comparing FNAB with core needle biopsy. Bennert et al.
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More important, the core needle biopsy did not contribute to patient management. To the authors' knowledge, this study represents the largest series in the cytopathology literature. There are no distinctive cytologic features specific for MFH. Aspirates smears are typically cellular, with individual cells displaying obviously malignant features. There were a few cases in which there was a single tumor cell population of spindle morphology; one of these cases was a LMS in which the nuclei had more of a blunted shape Fig.
Another represented an unclassifiable sarcoma with a pattern of small cells Fig. Unfortunately, the use of ancillary immunohistochemistry was not particularly helpful in the subclassification of the cases in the current study. The generally low mitotic activity observed in the cytologic cases of MFH is an unexpected but interesting finding; intuitively, one would expect relatively high mitotic rates, as identified in tissue sections.
Prior quantification of mitoses has not been previously reported. A few articles mention the presence of mitoses with qualifications of typical and atypical. This latter case diagnosed as MFH represented an organizing thrombus in the suprapubic region. The atypia observed in the FNAB was misinterpreted due to very low cellularity and obscuring blood and inflammation.
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As in any other body site, diagnosing malignancy on suboptimal or inadequate aspirate material is a repeatedly treacherous pitfall. In the less specific categories of pleomorphic and spindle cell sarcoma, most of these tumors were histologically confirmed as MFH.
The differential diagnosis of MFH includes any pleomorphic mesenchymal tumor, and pleomorphic nonmesenchymal tumor, such as anaplastic carcinoma and malignant melanoma. The distinction from MFH typically requires clinical and radiographic correlation with cytopathology, as well as ancillary testing. More specific subtyping of sarcomas by FNAB is more problematic. Therefore, there is a strong argument for trying to eliminate specific subtyping of sarcomas by FNAB, and instead adopting more descriptive terminology reflective of tumor grade. The latter, as well as tumor size and depth, are prognostically valuable in patient management.
Perhaps the best approach is to categorize these lesions by FNAB as follows: nonneoplastic, benign mesenchymal neoplasm, sarcoma low or high grade , or spindle cell neoplasm, not further classifiable.
kamishiro-hajime.info/voice/comment-espionner/espion-telephone-windows-phone.php Any further classification, if necessary, may be reserved for the surgical specimen. The diagnosis of MFH is typically one of exclusion, when evidence of more specific differentiation cannot be demonstrated. Of the remaining cases considered as MFH, there were no consistent morphologic characteristics that identified these tumors as MFH.
Fletcher also pointed out that subclassification of pleomorphic sarcomas provided little additional information clinically, because prognosis and treatment response remained unaffected. The vast majority of the cytology cases in the current study did not have cell block material, or sufficient aspirate smears to perform an extensive immunohistochemical panel necessary to subcategorize the sarcomas.
In the absence of such ancillary testing, the diagnosis of MFH was made based on cytologic appearance and clinical presentation. In the less specific categories of pleomorphic and spindle cell sarcoma, most of these tumors were histologically confirmed as MFH. The differential diagnosis of MFH includes any pleomorphic mesenchymal tumor, and pleomorphic nonmesenchymal tumor, such as anaplastic carcinoma and malignant melanoma. The distinction from MFH typically requires clinical and radiographic correlation with cytopathology, as well as ancillary testing.
More specific subtyping of sarcomas by FNAB is more problematic. Therefore, there is a strong argument for trying to eliminate specific subtyping of sarcomas by FNAB, and instead adopting more descriptive terminology reflective of tumor grade. Perhaps the best approach is to categorize these lesions by FNAB as follows: nonneoplastic, benign mesenchymal neoplasm, sarcoma low or high grade , or spindle cell neoplasm, not further classifiable.