Cytological diagnosis of adrenocortical carcinoma: A report of 2 cases in children

Self Cite

Background: Cytology of the adrenal gland is a less performed technique even in tertiary care centres; yet cytological evaluation is an important diagnostic tool for assessment of adrenal lesions. Our objective was to evaluate the diagnostic utility of FNAC smears and cellblock with immunohistochemistry (IHC) in lesions of the adrenal. Material and methods: We had a total of 50 cases over a period of 2 years where both FNAC smears and cellblocks were taken. The smears and cellblocks were examined for adequacy. They were subsequently categorised into four groups: unsatisfactory, benign, suspicious of malignancy and malignant. The diagnostic accuracy of FNAC smears and cellblock with IHC were evaluated and compared, taking histopathology, wherever available, as the gold standard, Result: We had 50 cases with age ranging from 6 to 53 years with a median of 7.5 years. Of these, 54% were cytologically malignant and neuroblastoma was the commonest lesion. Histopathology was available in 23 cases only, where the diagnostic accuracy was evaluated. The sensitivity and specificity of FNAC smear was 100% and 85.71%, respectively whereas the sensitivity and specificity of cellblock with IHC was 100% and 92.86%, respectively. Conclusion: Cellblock together with IHC provides a higher degree of specificity, reduces the unsatisfactory rate and improves the diagnostic accuracy in lesions of the adrenal gland. Immunohistochemistry is an important adjunctive tool.

“…We had four cases of adrenocortical carcinoma 11 . One case, diagnosed as malignant on cytology showed clear cut features of malignancy.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: T a B L Ementioning

confidence: 99%

See 1 more Smart Citation

Diagnostic utility of cytology smears and cell block in adrenal lesions

Mukherjee

Sengupta

Das

et al. 2020

Self Cite

“…Our study also included three cases of ACTs. Amongst them, two were later diagnosed as adrenocortical carcinoma on histological examination 13 . CB is essential in establishing adrenocortical origin of these tumours as alpha inhibin and SF1 are useful IHCs for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Utility of cell block preparation in diagnosis of paediatric abdominal neoplasms

Kanjilal

Das²,

Chatterjee

et al. 2020

Self Cite

Background Paediatric abdominal neoplasms are fairly common. Fine needle aspiration cytology (FNAC) is used for the initial evaluation of paediatric abdominal neoplasms. However, sometimes FNA interpretation can be difficult on limited material, owing to tumour heterogeneity and overlapping features. Therefore, we attempted to obtain additional information using cell block (CB) preparation from residual aspiration material along with immunohistochemistry (IHC) to enhance the diagnostic accuracy. Aim To evaluate the correlation between CB preparation and FNAC in diagnosis of paediatric abdominal tumours with the help of an extended panel of IHC markers and to highlight some of the diagnostic difficulties. Materials and methods A total of 113 cases of paediatric abdominal masses were studied. In addition to routine FNA smears, CBs were prepared from the residual material for IHC analysis as considered appropriate. Results This study included a total of 113 children with abdominal masses. Histopathology following surgical resection was available in 53 cases. Histology was taken as gold standard to measure the diagnostic accuracy with reference to sensitivity (Sn), specificity (Sp), positive predictive value and negative predictive value. The Sn of FNA alone was 87.5% and Sp was 97.78%. The Sn and Sp increased with use of CB alone and were 100% and 97.78% respectively. The highest Sn and Sp were observed when CB was combined with IHC where both the values were 100%. Conclusion CB with IHC is a useful adjunct to the routine FNA smears that further contributes to enhance the accuracy of the cytopathological diagnosis and is useful for choosing pre‐operative chemotherapeutic regimen.

“…As percutaneous access to the lesions is difficult due to its anatomic location; FNA cytologic features of ACC have been only sporadically described. The cytologic features of ACC are summarised as atypical cells with elevated N/C ratio, conspicuous nuclear pleomorphism, irregular nuclear membrane, and vacuolated cytoplasm appear singly or as loose aggregate . In a series of the cytology of ACC, the common cytologic features diagnostic of ACC were hypercellularity (70% of cases), necrotic debris in the background (70%), moderate to marked nuclear pleomorphism (80%), mitotic figures (90%), and prominent nucleoli (60%).…”

Section: Commentmentioning

confidence: 99%

Imprint cytology of adrenal cortical carcinoma. A valuable surrogate for frozen sections

Sakuma¹,

Kokubo²,

Koike³

et al. 2019

K E Y W O R D S : adrenal, adrenocortical carcinoma, cytology, fine needle aspiration, metaplastic ossification 1 | INTRODUCTION Adrenal cortical carcinoma (ACC) is a rare tumour, and its cytological findings have been described only sporadically. We here report a case of ACC in which imprint cytology played an important role in the diagnosis. Cytological findings of ACC are shown and the correlation to the histology is discussed. | OBSERVATIONA 74-years-old woman presented with right hypochondralgia and subfever. Ultrasonography (US) and blood tests suggested cholecystitis/cholangitis, which was successfully treated with antibiotics. A 66 × 38 mm-sized asymptomatic tumour was incidentally discovered around the upper pole of the left kidney. Calcification foci were scattered within the tumour (not shown). The adrenal endocrinological functions, both cortical and medullary, remained within normal range. Access to the lesion with fine needle aspiration (FNA) was difficult due to its deep location. Systemic imaging surveys showed no other tumours, so the lesion was clinically diagnosed as a potentially malignant tumour of adrenal origin. The pathologic diagnosis was to be made during the operation with frozen sections. Incision biopsy did not cut well. The sections broke into pieces. Imprint cytology was made instead and stained for rapid cytodiagnosis. The imprint slides were hypercellular. Numerous atypical cells with marked nuclear/cytoplasmic pleomorphism were seen in a haemorrhagic/necrotic background. The tumour cells had clearly defined cell border, and they showed little mutual adhesion. Anisonucleosis, irregularity of the nuclear membrane, conspicuous large eosinophilic nucleoli, and coarsely clumped chromatin were present. Multinuclear cells were often seen. Mitotic figures were occasionally observed (Figure 1A-D). These cytological findings suggested a high-grade neoplasm. According to this positive cytodiagnosis, left adrenalectomy with radical nephrectomy was performed. Permanent histologic sections of the tumour prepared after decalcification showed proliferation of atypical cells with clear cytoplasm. Approximately one thirds of the tumour was occupied with a diffuse proliferation of tumour cells (Figure 2). Remaining two thirds showed trabecular pattern covered by thin fibrous connective tissue, which was interpreted as vestigial adrenal cortex histology (not shown). In the histologic specimens, N/C ratio was lower and cellular/nuclear atypia was less obvious when compared with cytology. Besides necrosis and associated microcalcification, metaplastic ossification was widely observed ( Figure 2B). However, neither bone marrow formation nor haematopoietic myeloid cells were seen. This mature bone trabecular formation was thought to be responsible for the failure of frozen sections cutting. Mitotic figures were seen two to five per 10 high power fields (not shown). Capsular invasion ( Figure 2C) and venous invasion ( Figure 2D) were recognised. Immunohistochemically, synaptophysin and chromogranin A wer...