Cytopathology of Soft Tissue and Bone Lesions (eBook)

Cytopathology of SoftTissue and Bone Lesions 3
Series Preface 7
Contents 9
1: Introduction to Soft Tissue and Bone Cytopathology: A Practical Approach 11
References 15
2: Diagnostic Accuracy of FNA of Soft Tissue and Bone Lesions 17
References 19
3: Cytopathology of Spindle Cell Lesions of Soft Tissue and Bone 21
Granulomatous Inflammation with Spindle Cell Morphology3,4 (Fig. 3.1) 22
Cytomorphology 22
Differential Diagnosis 22
Ancillary Studies 22
Pseudosarcomas (Nodular Fasciitis, Myositis ­Ossificans, and Proliferative Fasciitis5) (Figs. 3.2 and 3.3) 23
Histological Features 24
Cytomorphology of Pseudosarcomas 24
Differential Diagnosis 26
Ancillary Studies 26
Summary and Key Features 26
Benign Neurgogenic Tumor6,7 (Schwannomaand Neurofibroma) (Fig. 3.4) 26
Cytomorphology of Neurofibroma/Schwannoma 28
Ancillary Studies 28
Differential Diagnosis 28
Spindle Cell Lipoma8,9 (Fig. 3.5) 28
Differential Diagnosis 29
Solitary Fibrous Tumor4,10 (Fig. 3.6) 30
Cytomorphology of Solitary Fibrous Tumor 31
Ancillary Studies 31
Aneurysmal Bone Cyst11–13 (Fig. 3.7) 31
Cytomorphology of Aneurysmal Bone Cyst 31
Differential Diagnosis 32
Leiomyosarcoma14–16 (Fig. 3.8) 33
Cytomorphology of Leiomyosarcoma 34
Differential Diagnosis 34
Myxofibrosarcoma/Myxoid MFH17–-19 (Fig. 3.9) 34
Cytomorphology of Myxoid MFH 34
Differential Diagnosis 35
Summary/Key Features 36
Fibrosarcoma15,20 (Fig. 3.10) 36
Cytomorphology of Fibrosarcoma 37
Differential Diagnosis 37
Osteosarcoma21–24 (Fig. 3.11) 37
Cytomorphology of Osteosarcoma 37
Differential Diagnosis 38
Ancillary Studies 39
Angiosarcoma25,26 (Fig. 3.12) 39
Cytomorphology of Angiosarcoma 39
Ancillary Studies 40
Differential Diagnosis 40
Kaposi Sarcoma22,27 (Fig. 3.13) 40
Cytomorphology of Kaposi Sarcoma 42
Ancillary Studies 42
Differential Diagnosis 42
Malignant Peripheral Nerve Sheath Tumor28,29 (Fig. 3.14) 43
Cytomorphology of MPNST 43
Ancillary Studies 44
Differential Diagnosis 44
Spindle Cell Melanoma30,31 (Fig. 3.15) 44
Cytomorphology of Spindle Cell Melanoma 44
Ancillary Studies 45
Differential Diagnosis 45
Pleomorphic/Spindle Cell Carcinoma32,33 (Fig. 3.16) 46
Cytomorphology of Spindle Cell Carcinoma 46
Ancillary Studies 47
Differential Diagnosis 47
Summary 47
References 48
4: Cytopathology of Soft Tissue and Bone Lesions Containing Giant Cells 51
Giant Cell Tumor of Tendon Sheath/Pigmented Villonodular Synovitis4–9 (Fig. 4.1) 52
Cytomorphology of Giant Cell Tumor of Tendon Sheath 52
Ancillary Studies 54
Differential Diagnosis 54
Giant Cell Tumor of Bone10,11 (Figs. 4.2 and 4.3) 54
Cytomorphology of Giant Cell Tumor of Bone 54
Ancillary Studies 55
Differential Diagnosis 55
Aneurysmal Bone Cyst12–14 (Fig. 4.4) 56
Cytomorphology of Aneurysmal Bone Cyst 57
Differential Diagnosis 58
Myelolipoma15 (Fig. 4.5) 58
Cytomorphology of Myelolipoma 58
Differential Diagnosis 59
Subcutaneous Fat Necrosis16–18 (Fig. 4.6) 59
Cytomorphology of Fat Necrosis 60
Ancillary Studies 60
Differential Diagnosis 61
Nodular Fasciitis and Myositis Ossificans16 (Fig. 4.7) 61
Cytomorphology of Nodular Fasciitis & Myositis Ossificans
Ancillary Studies 62
Differential Diagnosis 62
Sarcomas with Giant Cell/Pleomorphic Morphology19–23 (Figs. 4.8–4.10) 62
Cytomorphology of Sarcomas with Giant Cells 62
Ancillary Studies 63
Differential Diagnosis 63
Metastatic Giant Cell Carcinoma of Lung, Pancreas,2 Thyroid, or Kidney (Fig. 4.11) 64
Ancillary Studies 65
Differential Diagnosis 65
Metastatic Malignant Melanoma24,25 (Fig. 4.12) 66
Ancillary Studies 67
Differential Diagnosis 67
Anaplastic Large Cell Lymphoma Involving Soft Tissue or Bone26,27 (Fig. 4.13) 68
Cytomorphology of ALCL 69
Ancillary Studies 69
Differential Diagnosis 69
Summary 69
References 70
5: Cytopathology of Myxoid Soft Tissue Lesions 73
Nodular Fasciitis with Myxoid Changes (Figs. 5.1 and 5.2) 74
Histological Features 76
Cytomorphology of Nodular Faciitis with Myxoid Changes3 77
Ancillary Studies 77
Differential Diagnosis 78
Summary and Key Features 78
Myositis Ossificans with Myxoid Changes (Fig. 5.3) 78
Histology 78
Cytomorphology 79
Ancillary Studies: Same as Nodular Fasciitis 80
Differential Diagnosis 80
Ganglion Cyst (Fig. 5.4) 80
Histology 80
Cytomorphology of Ganglion Cyst3–5 81
Ancillary Studies 82
Differential Diagnosis 82
Myxoma (Figs. 5.5 and 5.6) 82
Histology 82
Cytomorphology of Myxoma3–7 84
Ancillary Studies 85
Differential Diagnosis 85
Neurilemoma/Schwannoma with Myxoid Features (Fig. 5.7) 85
Histology 85
Cytomorphology of Neurilemoma/Schwannoma 87
Ancillary Studies 87
Differential Diagnosis 87
Neurofibroma with Myxoid Features (Fig. 5.8) 87
Histology 88
Cytomorphology of Neurofibroma with Myxoid Features 89
Ancillary Studies 89
Differential Diagnosis 89
Chondroma with Myxoid Features (Fig. 5.9) 89
Histology 91
Cytomorphology of Chondroma with Myxoid Features4,5 91
Ancillary Studies 91
Differential Diagnosis 92
Myxoid Liposarcoma (Figs. 5.10a, b) 92
Histology 94
Cytomorphology of Myxoid Liposarcoma 94
Ancillary Studies 94
Differential Diagnosis 94
Myxofibrosarcoma/Myxoid MFH (Figs. 5.11 and 5.12) 95
Histology 97
Cytomorphology of Myxoid MFH 98
Differential Diagnosis 98
Summary/Key Features 98
Extraskeletal Myxoid Chondrosarcoma: Fig. 5.13 98
Histology 100
Cytomorphology of Extraskeletal Myxoid Chondrosarcoma5–7 100
Ancillary Studies 100
Chordoma (Fig. 5.14a, b)8-19 101
Histology 102
Cytomorphology of Chordoma8 103
Ancillary Studies 103
Differential Diagnosis 103
Low-grade Fibromyxoid Sarcoma(Fig. 5.15)6,7,10,19 103
Histology 104
Cytomorphology of Low Grade Fibromyxoid Sarcoma 105
Ancillary Studies 105
Differential Diagnosis 105
Metastatic Mucinous Carcinoma (Figs. 5.16a, b and 5.17) 105
Histology 108
Cytomorphology 108
Ancillary Studies 108
Differential Diagnosis 108
Pitfalls of Cytological Diagnosis of Myxoid Soft Tissue Lesions19-22 109
Summary 111
Benign Differential and Key Features 111
Malignant Differential and Key Features 112
References 113
6: Cytopathology of Soft Tissue Lesions with Predominance of Epithelioid, Round/Polygonal Cells, Glandular Cells, Inflammatory Cells 115
Tumors with Predominance of Epithelioid/Polygonal Cells 116
Rhabdomyoma (Adult Type) (Fig. 6.1) 116
Cytomorphology of Adult Rhabdomyoma 117
Ancillary Studies 118
Differential Diagnosis 118
Granular Cell Tumor (Fig. 6.2) 118
Cytomorphology of Granular Cell Tumor: Benign 118
Ancillary Studies 120
Differential Diagnosis 120
Cytomorphology of Granular Cell Tumor: Malignant (Fig. 6.3) 120
Epithelioid Sarcoma (Fig. 6.4) 120
Cytomorphology of Epithelioid Sarcoma 120
Ancillary Studies 123
Differential Diagnosis 123
Epithelioid Leiomyosarcoma (Fig. 6.5) 123
Ancillary Studies 125
Differential Diagnosis 125
Epithelioid Malignant Peripheral Nerve Sheath Tumor (Fig. 6.6) 125
Cytomorphology of Epithelioid MPNST 125
Ancillary Studies 127
Differential Diagnosis 127
Epithelioid Angiosarcoma (Fig. 6.7) 127
Cytomorphology of Epithelioid Angiosarcoma 127
Ancillary Studies 129
Differential Diagnosis 129
Epithelioid Hemangioendothelioma (Fig. 6.8) 129
Ancillary Studies 131
Differential Diagnosis 131
Extrarenal Rhabdoid Tumor (Fig. 6.9) 131
Cytomorphology of Extrarenal Rhabdoid Tumor 131
Ancillary Studies 133
Pleomorphic Rhabdomyosarcoma (Fig. 6.10) 133
Cytomorphology of Pleomorphic Rhabdomyosarcoma 133
Ancillary Studies 133
Clear Cell Sarcoma (Fig. 6.11) 134
Cytomorphology of Clear Cell Sarcoma 136
Ancillary Studies 136
Differential Diagnosis 136
Alveolar Soft Part Sarcoma (Fig. 6.12) 136
Cytomorphology of Alveolar Soft Part Sarcoma 137
Ancillary Studies 138
Differential Diagnosis 138
Synovial Sarcoma: Poorly Differentiated 138
Metastatic Tumors (Figs. 6.13–6.15) 138
Cytomorphology of Metastatic Tumors: Melanoma (Fig. 6.14) 140
Cytomorphology of Metastatic Tumors: Carcinomas (Figs. 6.15a, b) 142
Cytomorphology of Metastatic Tumors: Epithelial Mesothelioma (Fig. 6.16) 142
Lymphoma (Fig. 6.17) 142
Cytomorphology of Non-Hodgkin Lymphoma with Epithelioid Cells 144
Ancillary Studies 145
Differential Diagnosis 145
Cytomorphology of Hodgkin Lymphoma 145
Ancillary Studies 146
Differential Diagnosis 147
Cytomorphology of Plasmacytoma (Fig. 6.18) 147
Ancillary Studies 147
Differential Diagnosis 147
Tumors with Predominance of Round Cells 147
Rhabdomyosarcoma (Figs. 6.19 and 6.20) 147
Cytomorphology of Rhabdomyosarcoma: Alveolar (Fig. 6.19) 150
Ancillary Studies 151
Differential Diagnosis 151
Cytomorphology of Rhabdomyosarcoma: Embryonal (Fig. 6.20) 151
Ancillary Studies 152
Differential Diagnosis 152
Ewing Sarcoma/Primitive Neuroectodermal Tumor: PNET (Fig. 6.21) 152
Cytomorphology of Ewing/PNET 154
Ancillary Studies 154
Differential Diagnosis 154
Neuroblastoma (Fig. 6.22) 155
Cytomorphology of Neuroblastoma 156
Ancillary Studies 157
Differential Diagnosis 157
Desmoplastic Small Round Cell Tumor (Fig. 6.23) 157
Cytomorphology of DSRCT 159
Ancillary Studies 160
Differential Diagnosis 160
Poorly Differentiated Synovial Sarcoma (with Round Cells) (Fig. 6.24) 160
Cytomorphology of Poorly Differentiated Synovial Sarcoma with Round Cells 160
Ancillary Studies 162
Differential Diagnosis 162
Extraskeletal Myxoid Chondrosarcoma (Fig. 6.25) 162
Cytomorphology of Extraskeletal Myxoid Chondrosarcoma (Cellular Variant) 162
Paraganglioma (Fig. 6.26) 162
Cytomorphology of Paraganglioma 162
Ancillary Studies 164
Differential Diagnosis 165
Glomus Tumor (Fig. 6.27) 165
Cytomorphology of Glomus Tumor 165
Ancillary Studies 165
Differential Diagnosis 165
Solitary Fibrous Tumor (Fig. 6.28) 165
Cytomorphology of Solitary Fibrous Tumor 166
Ancillary Studies 168
Differential Diagnosis 168
Non-Hodgkin Lymphomas (Fig. 6.29) 168
Cytomorphology of Non-Hodgkin Lymphomas 168
Ancillary Studies 168
Differential Diagnosis 168
Soft Tissue Lesions with Predominance of Inflammatory/Reactive Cells 169
Inflammation (Figs. 6.30–6.32) 169
Cytomorphology of Inflammation 171
Fasciitis/Myositis (Fig. 6.33) 173
Cytomorphology of Fasciitis/Myositis 173
Differential Diagnosis 175
Fat Necrosis (Fig. 6.34) 175
Cytomorphology of Fat Necrosis70 177
Muscle Regeneration (Fig. 6.35) 177
Cytomorphology of Muscle Regeneration 177
References 177
7: Cytopathology of Adipocytic Soft Tissue Tumors 183
Introduction 183
Adipocytic Tumors Resembling Fat 184
Lipoma NOS (Figs. 7.1–7.5) 184
Cytomorphology of Lipoma 184
Differential Diagnosis 188
Variants of Lipoma 190
Angiolipoma (Fig. 7.6) 191
Cytomorphology of Angiolipoma 192
Differential Diagnosis 192
Chondroid Lipoma (Fig. 7.4) 192
Cytomorphology of Chondroid Lipoma 192
Differential Diagnosis 193
Hibernoma (Fig. 7.7) 193
Cytomorphology of Hibernoma 193
Differential Diagnosis 195
Lipoblastoma (Fig. 7.8) 195
Cytomorphology of Lipoblastoma 195
Ancillary Studies 196
Differential Diagnosis 196
Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma (Fig. 7.9) 197
Cytomorphology of ALT/WDL 197
Ancillary Studies 199
Differential Diagnosis 199
Adipocytic Tumors with Spindle Cells 199
Spindle Cell Lipoma (Fig. 7.10) 199
Cytomorphology of Spindle Cell Lipoma 199
Differential Diagnosis 200
Spindle Cell Variant of ALT/WDL (Fig. 7.11) 201
Cytomorphology of Spindle Cell Variant of ALT/WDL 202
Differential Diagnosis 202
Ancillary Studies 202
Myxoid Adipocytic Tumors 202
Myxoid Liposarcoma (Figs. 7.12 and 7.13) 202
Cytomorphology of Myxoid Liposarcoma 203
Ancillary Studies 205
Differential Diagnosis 205
Myxomatous Variants of Other Adipocytic Tumors 205
Round Cell Adipocytic Tumors 205
Round Cell Liposarcoma 205
Cytomorphology of Round Cell Liposarcoma 205
Ancillary Studies 206
Pleomorphic Adipocytic Tumors 206
Pleomorphic Lipoma (Fig. 7.14) 206
Cytomorphology of Pleomorphic Lipoma 206
Differential Diagnosis 208
Pleomorphic Liposarcoma (Fig. 7.15) 208
Cytomorphology of Pleomorphic Liposarcoma 209
Ancillary Studies 209
Differential Diagnosis 209
Dedifferentiated Liposarcoma (Fig. 7.16) 209
Cytomorphology of Dedifferentiated Liposarcoma 211
Pitfalls in Adipocytic Tumors 211
References 212
8: Utilizing Cytology as an Adjunct to Frozen Section to Enhance the Intraoperative Diagnosis of Bone and Soft Tissue Tumors 214
Most Common Reasons for Intraoperative Pathologic Consultation 215
Cytological Preparations 216
Case Illustrations of the Most Commonly Encountered Clinical Scenario in Which Cytology Enhances the Intraoperative Diagnosis of Sarcoma 218
References 231
9: Ancillary Studies in FNAC of Soft Tissue and Bone Lesions 232
Spindle Cell Malignancy 234
Round Cell Malignancy 236
Epithelioid Cell Morphology 240
Lipid Cell Morphology 240
Metastatic Disease Morphology 245
References 252
Index 254