Evaluation of pediatric abdominal masses by fine‐needle aspiration cytology: A clinicoradiologic approach

Abstract

The pathologist forms a very important part of the clinical team in the management of pediatric intra-abdominal masses in giving a rapid, accurate diagnosis for these potentially curable tumors. Fine-needle aspiration cytology (FNAC) is an invaluable tool in this regard when interpreted with clinicoradiologic parameters. With this in mind, we decided to evaluate the role of FNAC in pediatric abdominal masses in our institution. A total of 83 of 105 FNAC accessioned in the pathology department over 5 years (2003-2007) were studied. These included only cases where a diagnosis could be offered on cytology. Detailed clinicoradiological features were obtained from hospital records. Cytomorphological features examined included cellularity, architectural pattern, background, key cellular details. Immunocytochemistry were done where necessary. Lesions diagnosed on FNAC included Wilms' tumor (19), lymphoma (10), neuroblastoma (6), hepatoblastoma (5), PNET (5), rhabdomyosarcoma (2), DSRCT (2), germ cell tumor (6), and miscellaneous tumors (7). Definite diagnosis could be offered on cytomorphology in 74.7% (62) cases, while in 25.3% (21) cases only a diagnosis of round cell tumor could be offered. Concordance with final histopathology and biochemical parameters was subsequently obtained in 79/83 (95.5%) of cases. A clinically relevant classification is possible on FNAC in pediatric abdominal tumors when interpreted with clinicoradiologic parameters. This obviates the need for a more time-consuming biopsy procedure in critical situations and in stage II nephroblastoma where it is contraindicated.

Fine-needle aspiration cytopathology in the diagnosis of Wilms tumor

“…A diagnosis of anaplasia on cytology is made when a smear shows extremely large hyperchromatic blastemal cells three times the size of the surrounding blastemal cells coupled with brisk atypical mitosis. A potential limitation of FNAC on WT is the inability to extensively sample a large mass and thereby to detect anaplasia and to distinguish focal from diffuse anaplasia [18,22].…”

“…ICC for WT1, cytokeratin, synaptophysin, leucocyte common antigen and MIC2 are used for diagnosis of small round cell tumors of the kidney, while WT1, bcl2, vimentin and desmin are used for evaluation of spindle cell tumors in that region [22,24].…”

Pediatric neuroblastic tumors: A critical evaluation of cytomorphological features for risk stratification on aspiration cytology

“…Spread of the tumor along needle track as a result of seedling is also one of the disadvantages of core needle biopsy . FNA is a relatively safe, inexpensive, rapid diagnostic procedure which is widely accepted specially in inaccessible sites and uncooperative patients …”

“…16 FNA is a relatively safe, inexpensive, rapid diagnostic procedure which is widely accepted specially in inaccessible sites and uncooperative patients. [17][18][19][20][21] A detailed evaluation of cytomorphological features of FNA cytol- Cellularity 3 2 3 3 3 3 2 2 3 2 % of stroma verses neuroblasts 2 2 3 3 3 3 2 2 3 2 Maturity score 2 3 3 1 3 3 1 2 3 2 M K I 2 3 3 1 3 3 2 3 3 2 Homer-Wright Rosette score ICC in 30% of cases. Diagnostic accuracy was also found to be high in a study by Frostad et al 2 In the current study, we have the diagnostic accuracy of 100% with all cases being further verified by IHC performed on cell block sections or smears.…”

Diagnostic and prognostic information obtained on fine‐needle aspirates of primary neuroblastic tumors

“…Only single reports have analyzed the value of cytologic aspirates as cellular material used for genomic techniques. [3][4][5][6][7][8][9][10][11][12] Cytological diagnosis in pediatric tumors has been used at the Institut Curie since 1984. In our previous report of cases recruited between 1987 and 1999, 13 147 patients were diagnosed with neuroblastic tumors using cytology.…”