We describe an unusual case of chondroblastic osteosarcoma of the skull in an 11‐yr‐old girl in whom a preoperative diagnosis was made by fine‐needle aspiration (FNA) biopsy, followed by histologic confirmation of tissue biopsy and the surgically resected specimen. FNA cytology revealed pleomorphic oval cells with prominent nucleoli along with spindle cells, tumor giant cells, and a chondromyxoid background. The cell block of the aspirated material showed osteoid associated with the malignant cells. Immunocytochemical stains revealed S‐100 and vimentin positivity; actin, myoglobin, and cytokeratin stains were negative. Electron microscopy revealed neoplastic cells with chondrocytic differentiation. This case demonstrates the value of FNA biopsy combined with immunocytochemical and ultrastructural studies performed on the aspirated material in diagnosing osteosarcoma from an unusual location such as the base of the skull. Diagn Cytopathol 1996;14:51–55. © 1996 Wiley‐Liss, Inc.
We describe an unusual case of chondroblastic osteosarcoma of the skull in an 11-yr-old girl in whom a preoperative diagnosis was made by fine-needle aspiration (FNA) biopsy, followed by histologic confirmation of tissue biopsy and the surgically resected specimen. Key Words: Osteosarcoma; Skull; FNA biopsy; Cytology Fine-needle aspiration (FNA) biopsy is a useful technique in the evaluation of bone lesions; it has a low complication rate and allows minimal disturbance of malignant lesions prior to preoperative radiation and chemotherapy. The diagnosis of bone lesions can be difficult, but when the cytopathology is interpreted along with the clinical information and radiologic features, the correct diagnosis can be made in the majority of cases, when occurring in the usual locations. ' However, FNA biopsy of osteosarcomas occurring in unusual locations, such as the base of the skull, can be especially challenging. We describe a case of chondroblastic osteosarcoma in an unusual head and neck location in an 1 1-yr-old female. The diagnosis was made by FNA biopsy and later histologically confirmed. Case ReportAn 11-yr-old, previously healthy girl presented with a 6-wk history of left ear pain. She was treated with three different antibiotics for otitis media without resolution of symptoms. She later developed left eye pain, orbital swelling, and partial loss of vision, with ophthalmologic examination confirming proptosis of the left eye and sixth cranial nerve palsy. A magnetic resonance image showed a large mass involving the left base of the skull (Fig. 1). The epicenter was in the pterygopalatine fossa, with extension into the cavernous sinus and sphenoid sinus and invasion of the sell turcica. Superiorly, the mass extended into the greater wing of the sphenoid bone. There was bony extension of the mass into the left middle cranial fossa, and the mass abutted the anterior aspect of the left temporal lobe. A bone scan for metastatic disease was negative. The clinical and radiologic impression was rhabdomyosarcoma vs. osteosarcoma. The patient underwent FNA biopsy of the base of the skull by using a 22-gauge needle followed by endoscopic biopsy for histologic confirmation. Air-dried and alcohol-fixed slides were prepared from the aspirated material. Some of the air-dried smears were stained with Diff-Quik for immediate interpretation; the remaining slides were alcohol-fixed and later stained with Papanicolaou stain. A portion of the aspirate was set aside for electron microscopy, and two cell blocks for histologic examination were prepared. A diagnosis of chondroblastic type of osteogenic sarcoma was made (see sections on cytopathologic and histopathologic findings below).After FNA and tissue biopsies, the patient was treated with high-dose methotrexate, with leucovorin rescue and cisplatin with adriamycin. The follow-up computed tomography scan 2 mo after chemotherapy showed exten-@ 1996 WILEY-LISS, INC.
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