Fine needle aspiration cytology (FNAC) of cystic soft tissue lesions and end tissue metamorphosis-a three year study

Year 2019, , 46 - 53, 30.03.2019

Ragini Thapa , Rajveer Singh Beniwal Prosenjit Ganguly

https://doi.org/10.17546/msd.536237

Abstract

Objective: Superficial soft-tissue masses may be seen in clinical practice, but a
systematic approach may help to achieve a definitive diagnosis or differential
diagnosis for soft tissue lesions. The cystic lesions constitute a
heterogeneous group with highly varied etiology, cytology and diversified
histopathology. The aim of this study is to investigate the accuracy of FNAC
diagnosis of varied cystic lesions of soft tissue lesions by comparing with the
radiological and histopathology diagnosis.

Materials and
methods: Fine needle aspirations were done using a 22-24 gauge disposable needle and a 5cc to 10 cc
disposable syringe for suction. Wet-fixed smears with isopropyl alcohol were
stained with hematoxylin and eosin (HxE). Dry-fixed smears were stained with Leishman
Giemsa along with Papanicolaou stains (PAP) were studied for cytological
details and diagnosis. The excised surgical specimen and biopsy samples of the
cases were processed routinely and stained with HxE and immunohistochemistry
(IHC) panel was applied.

Results: Examined cystic soft-tissue masses were found as superficial (82%) and
deep (18%). Superficial lesions were categorized into mesenchymal tumors, skin
appendage lesions, tumor like lesions, pseudoudo tumoural soft tissue lesions
or parasitic /inflammatory lesions. Deeper lesions with cystic presentation
were mostly (74%) malignant. The differential diagnosis was done according to
the age of the patient, anatomic location of the lesion, salient imaging
features and clinical manifestations.

Conclusion: Although the fine
needle aspiration cytology of the cystic lesions, imaging characteristics of
the lesions discussed are not always corresponding to the histopathologic
findings what we assume, combining them with lesion location and clinical
features may allow the diagnosticians to suggest a specific diagnosis in most
cases.

Keywords

FNAC, Cystic soft tissue lesions

References

• 1. Domanski HA, Carlen B. Distinct cytologic features of spindle cell lipoma. A cytologic-histologic study with clinical, radiologic, electron microscopic, and cytogenetic correlations. Cancer 2001; 93: 381-9. 2. Bode-Lesnewska B. Cytologic diagnosis of soft tissue tumours. Pathologe 2007; 28; 368-76
• 2. Czeriak B ,Tuziak T Soft Tissue Lesions. In: Koss LG, Melamed MR, 5 ed. Koss' Diagnostic Cytopathology and its Histopathologic Bases , Philadelphia : Lippincott Williams & Wilkins; 2006.
• 3. Kulkarni DR , Kokandakar HR , Kumbhakarna NR,Bhople KS. Fine needle aspiration cytology of soft tissue tumours and correlation with histopathology. Indian J.Pathol.Microbiol.45(1):45-48,2002.
• 4. Paranjali S,Lakhey M.Efficacy of Fine needle aspiration cytology in diagnosis of soft tissue tumours.Journal of Pathology of Nepal(2012)vol.2 , 305-308.
• 5. Enzinger FM, Weiss SW. Soft tissue tumors, 4th edition, St. Louis, MO: Mosby, 2001.
• 6. Bharat R, Biru D G, Anagna C K, Chinoy RF. Scope of FNAC in the diagnosis of soft tissue tumors. Cytojournal 2007, 4: 20.
• 7. Kilpatrick SE, Cappellari JO, Bos GD, Gold SH, Ward WG. Is fine needle aspiration biopsy a practical alternative to open biopsy for the primary diagnosis of sarcoma? Experience with 140 patients. Am J Clin Pathol 2001; 115(1): 59-68.
• 8. Akerman M, Willen H, Carleu B. Fine needle aspiration in the diagnosis of soft tissue tumors; a review of 22yrs experience. Cytopathology 1995; 6: 236-47.
• 9. Mirrales TG, Gonzelleza F, Menedez T. Fine needle aspiration cytology of soft tissue lesions. Acta cytological 1986; 30: 671-8.
• 10. Enzinger FM, Weiss SW. Soft tissue tumors, 4th edition, St. Louis, MO: Mosby, 2001.
• 11. Talati N, Pervez S. Soft Tissue sarcomas: pattern diagnosis or entity? J Pak Med Assoc 1998;48(9): 272-5.
• 12. Campora ZR, Salaverri OC, Vazquez HA et al. Fine needle aspiration in myxoid tumors of the soft tissues. Acta Cytol 1990; 34: 179.
• 13. Wakely PE Jr, Kneisl JS. Soft tissue aspiration cytopathology. Cancer 2000; 90(5): 292-8.
• 14. Campora RG, Arias GM. FNAC of primary soft tissue tumor. Acta Cytol 1992; 36: 905-917.
• 15. J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 27/July 06, 2015 Page 4026
• 16. Galant J, Marti-Bonmati L, Soler R, Saez F, Lafuente J, Bonmati C, et al. Grading of subcutaneous soft tissue tumors by means of their relationship with the superficial fascia on MR imaging. Skeletal Radiol 1998;27:657–663.
• 17. Lagalla R, Iovane A, Caruso G, Lo Bello M, Derchi LE. Color Doppler ultrasonography of soft-tissue masses. Acta Radiol1998;39:421–426.
• 18. Chung HW, KILL HC. Ultrasonography of soft tissue “oops lesions” .KSUM 2015; 34(3): 217-225
• 19. Morel M, Taieb S, Penel N, Mortier L, Vanseymortier L, Robin YM, et al. Imaging of the most frequent superficial soft-tissue sarcomas. Skeletal Radiol 2011;40:271–284.
• 20. Calleja M, Dimigen M, Sa ifuddin A. MRI of superficial soft tissue masses: analysis of features useful in distinguishing between benign and malignant lesions. Skeletal Radiol 2012;41:1517–1524.
• 21. Hwang S, Panicek DM. The evolution of musculoskeletal tumor imaging. Radiol Clin North Am 2009;47:435–453.
• 22. Hong SH, Chung HW, C hoi JY, Koh YH, Choi JA, Kang HS. MRI findings of subcutaneous epidermal cysts: emphasis on the presence of rupture. AJR Am J Roentgenol 2006;186:961–966.
• 23. Vincent LM, Parker LA, Mittelstaedt CA. Sonographic appearance of an epidermal inclusion cyst. J Ultrasound Med 1985;4:609–611.
• 24. Lee HS, Joo KB, Song H T, Kim YS, Park DW, Park CK, et al. Relationship between sonographic and pathologic findings in epidermal inclusion cysts. J Clin Ultrasound 2001;29:374–383.
• 25. Lazarus SS, Trombetta L D. Ultrastructural identification of a benign perineurial cell tumor. Cancer 1978;41:1823–1829.
• 26. Navarro OM, Laffan EE , Ngan BY. Pediatric soft-tissue tumors and pseudo-tumors: MR imaging features with pathologic correlation: part 1. Imaging approach, pseudotumors , vascular lesions, and adipocytic tumors. Radiographics 2009;29:887–906.