Diagnostic utility of cytology smears and cell block in adrenal lesions

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.

Section: Discussionmentioning

confidence: 89%

“…However, reliably distinguishing ACC from ACA is difficult on FNAC and CB in absence of capsular and vascular invasion. These become even more difficult in paediatric patients where cytological features alone are not an adequate guide in favour of malignancy 14‐17 …”

Section: Discussionmentioning

confidence: 99%

Utility of cell block preparation in diagnosis of paediatric abdominal neoplasms

Kanjilal

Das²,

Chatterjee

et al. 2020

Self Cite

“…With the advent of new imaging modalities and the widespread use of imaging studies, the detection rate of adrenal nodules has increased enormously. Most of these lesions are detected during a staging workup for cancer elsewhere or for other complaints unrelated to the adrenal gland, often referred to as “incidentalomas.” 1–3 There are a number of etiologies giving rise to adrenal nodules including adrenal cortical adenoma, adrenal cortical carcinoma, pheochromocytoma, myelolipoma, and metastatic lesions. In patients with an adrenal mass and an extra‐adrenal malignancy, the frequency of this mass being metastatic can range from 32% to 73% 3 …”

Section: Introductionmentioning

confidence: 99%

Utility of rapid on‐site evaluation in procurement of adrenal gland tissue biopsies

Hojat

Maheshwari

Ravish

et al. 2022

Background: While the number of adrenal biopsies has increased due to more "incidentalomas" were detected by widespread use of imaging studies, there have been very limited studies to evaluate the utility of rapid on-site evaluation (ROSE) in obtaining adequate core needle biopsy (CNB) tissue for diagnosis of adrenal lesions. Methods:We retrospectively reviewed all percutaneous adrenal CNB cases with available ROSE for a 12-year period in our institute in order to assess the usefulness of ROSE in adrenal CNB sampling.Results: A total of 83 cases were identified in our database. The majority of cases (52/83, 63%) were diagnosed as metastatic malignancies with the lung being the most common primary site.

Pitfalls in Cytological Diagnosis of Extra Adrenal Paraganglioma and Pheochromocytoma: Experience From a Tertiary Care Center

Mukherjee,

Dey,

Khatun

et al. 2024

BackgroundPheochromocytoma and extra‐adrenal paragangliomas increasingly coming into light nowadays because of improved imaging techniques and biochemical investigations. There is sparse literature available regarding cytological findings of adrenal and extra‐adrenal paragangliomas.Material and MethodsWe studied 16 cytological specimens retrospectively over a period of 3 years, where subsequent histological diagnosis of phaeochromocytoma or paraganglioma was available.ResultsA total of 16 cytology specimens were studied. Nine patients had adrenal SOLs and seven patients had extra‐adrenal lesions. Age range was 12 to 60 years Majority of the cytology smears were cellular (87.5%). The smears were composed of small clusters as well as dispersed plasmacytoid cells with eccentric nuclei containing salt and pepper chromatin and moderate to abundant granular cytoplasm. Large cellular clusters mimicking the Zellballen pattern was present in one case. Anisonucleosis was mild to moderate, except in three cases where marked anisonucleosis posed diagnostic challenges. The background was hemorrhagic in all cases, however, two cases in addition had necroinflammatory background. All cases lacked mitotic activity and cytoplasm was delicate with indistinct cell borders. Bare oval nuclei were a frequent finding. Nuclear grooves or cytoplasmic vacuoles were absent. In 12 out of 16 cases, the initial cytological diagnosis correlated with final histological diagnosis, with an overall diagnostic accuracy of 75%. Four misdiagnosed cases had some atypical cytological features like marked anisonucleosis, necroinflammatory background, and presence of prominent nucleoli.ConclusionHere we have highlighted some of the distinguishing cytological features that can help in cytological diagnosis of paragangliomas. Hemorrhagic background with plasmacytoid morphology, granular cytoplasm, naked nuclei, and absence of mitosis are useful clues.