Fine‐needle aspiration of primary and recurrent benign fibrous histiocytoma: Classic, aneurysmal, and myxoid variants

Abstract

There is a limited number of correlative cytopathological studies of fibrous histiocytoma (FHC). To better define cytopathological criteria of diagnosis, we have reviewed fine-needle aspirates (FNA) from 36 FHCs (32 classical, 1 myxoid, and 3 aneurysmal variants on corresponding histological sections). Original cytological diagnoses were benign in 33 (91.7%) cases (22 accurate) and false positive in 3 (8.3%) cases. All smears were surprisingly homogenous and composed of histiocytic cells with finely vacuolated cytoplasm in 27 (75%) cases, small regular spindle cells in 25 (69%) cases, and giant cells in 17 (47%) cases. Histiocytic cells were attached to vascular structures in 9 (25%) cases. Slight cytonuclear atypia was seen in five (14%) cases. Three (8.3%) cases showed numerous siderophages. In two (5.6%) cases, there were abundant inflammatory backgrounds and in one (3%) case there was a scant myxoid background. Storiform patterns, round cells, prominent atypia, necroses, or mitotic figures were not seen. FHC should be differentiated from other benign, low- and intermediate-grade spindle-cell neoplasms such as low-grade fibrosarcoma, dermatofibrosarcoma protuberans, nodular fasciitis, spindle-cell malignant melanoma, and monophasic synovial sarcoma. Some cases may be misinterpreted as malignant, especially in cases of recurrence or in patients with a cancer history.

Nodular Fasciitis: Definitive Diagnosis by Fine Needle Aspiration

“…leiomyosarcoma, fibrosarcoma and undifferentiated sarcoma) [20,21,22,23,24]. High-grade sarcomas are typically composed of tumor cells with marked hyperchromasia and irregular nuclear membranes, often with consistently prominent nucleoli and significant numbers of often atypical mitotic figures.…”

Fine needle aspiration cytology of nodular fasciitis of the breast

“…Spindle cell‐rich FNA smears of FH show more distinct arrangement such as in sheets, papillary fronds, and storiform pattern than in NF. Foam cells, siderophages, roundish or polygonal histiocytic cells, and occasionally Touton‐type multinucleated giant cells are seen . These cytologic findings can be utilized for the differential diagnosis.…”

“…However, FH grows slowly, whereas NF proliferates rapidly. In the two reports of breast FH, spindle cell growth in FH was associated with more distinct fascicular/storiform cell arrangement than NF. FH shows short and intersecting fascicles of spindle cells with a loose crisscross pattern or an inconspicuous storiform arrangement occasionally associated with multinucleated giant cells (either foreign body or Touton type).…”

“…FH shows short and intersecting fascicles of spindle cells with a loose crisscross pattern or an inconspicuous storiform arrangement occasionally associated with multinucleated giant cells (either foreign body or Touton type). Cytologic features of FH, including that arising from the breast, have been described . Spindle cell‐rich FNA smears of FH show more distinct arrangement such as in sheets, papillary fronds, and storiform pattern than in NF.…”

O papel da citologia no diagnóstico das neoplasias músculo-esqueléticas: revisão sistemática

“…The various reasons mentioned for the above phenomenon are: inability to evaluate tissue architecture; 8,16 difficulty obtaining an appropriate sample, 2-4,6,9,17,18 difficulty recognizing the extracellular matrix, especially osteoid; 9,19 considerable variability in histological patterns 6 with similar aspects both among different malignant lesions and among benign, malignant and non-neoplastic lesions, 2,4,7,9, 16,19,20 difficulty in the histologic subtyping and grading of lesions. 7,8,12,13,19,21 It could be noted that few authors base the definitive treatment exclusively on cytopathological results 5,7-10 , which demonstrates that despite the degree of precision referred to by the authors, there is limited confidence in the method.…”