Mediastinal sarcomas: experience using fine needle aspiration cytopathology

Abstract

Fine needle aspiration (FNA) cytology is a sparsely used diagnostic method in the evaluation of mediastinal sarcomas in most medical centers worldwide with most literature citations regarding this category of malignancies consisting of small series and individual case reports. Most of these published studies highlight vascular sarcomas such as epithelioid hemangioendothelioma, and angiosarcoma, various subtypes of liposarcoma including well-differentiated liposarcoma, myxoid liposarcoma, and pleomorphic liposarcoma, malignant peripheral nerve sheath tumor, and sarcomas of uncertain differentiation, primary synovial sarcoma and the Ewing sarcoma family of tumors. This paucity of cytopathology reports regarding mediastinal sarcomas is in marked contrast to the almost daily application of endobronchial ultrasound (EBUS)-guided FNA biopsy for sampling mediastinal lymph nodes and mediastinal masses for primary and metastatic carcinomas which, of course, are considerably more common that any type of sarcoma in this location. EBUS, endoscopic ultrasound-guided (EUS) needle biopsy, and percutaneous image-guided biopsy using either core needle, fine-needle, or both can serve a potentially useful role for diagnostic sampling of mediastinal sarcomas, be they primary or metastatic. This review catalogues much of the published data regarding FNA cytopathology and its application to mediastinal sarcomas. An attempt is made to primarily highlight case series rather than individual case reports; however, due to the paucity of these, case reports are cited and discussed where appropriate.

A case report of a giant middle mediastinal leiomyosarcoma

“…The use of FNA cytology for the diagnosis of mediastinal sarcoma is debated and uncommonly employed. However, in our case, leiomyosarcoma diagnosis could be successfully done with FNA cytology, where cell morphology was paired with ancillary immunohistochemical staining and molecular methods, as mentioned elsewhere ( 7 ).…”

Primary liposarcoma of the anterior mediastinum in a patient who underwent viral pneumonia

“…Тонкоигольная аспирационная биопсия под КТ контролем позволяет до операции определить морфологический тип опухоли, основываясь на идентификации липобластов в биопсийном материале [12]. Повторная трансторакальная coreбиопсия опухоли под КТ контролем у нашего пациента не представляла технических сложностей, но с учетом клинических признаков дыхательной недостаточности не выполнялась во избежание возможных осложнений.…”

“…Миксоидные липосаркомы примерно в 95% случаев характеризуются транслокацией t (12;16) (q13; p11), приводящей к слиянию гена FUS-CHOP и в 5% случаев транслокацией t (12;22) (q13; q12), образующей слияние гена EWSR1-DDIT3. Плеоморфная липосаркома, наименее распространенный подтип липосаркомы, представляет собой саркому высокой степени злокачественности с различным количеством плеоморфных липобластов, несущих сложные количественные и структурные хромосомные аномалии [12,13].…”

Approach to Mediastinal Fine Needle Aspiration Cytology

“…Tumor cells have a high nuclear to cytoplasmic ratio, hyperchromatic nuclei, and nuclear pleomorphism. 66 Mitoses are easily identified. Apoptosis and necrosis may be seen (Fig.…”

“…Mediastinal sarcomas (primary or metastatic) are rare and are only uncommonly encountered in cytology as FNA or touch imprint specimens. Lott-Limbach and Wakely published a review article on mediastinal sarcomas on FNA specimens and summarized cytologic features of sarcomas including liposarcomas, angiosarcomas, MPNST, synovial sarcomas, and Ewing sarcoma 66…”