Utility of cell block preparation in diagnosis of paediatric abdominal neoplasms

Abstract

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.

Fine‐needle aspiration cytology of juvenile granulosa cell tumour: A case report with summary of prior published cases

“…Precise cytological diagnosis is important here as based on this, many of the patients receive specific pre-operative chemotherapy regimen such as in case of Wilms tumour, neuroblastoma and germ cell tumours such as yolk sac tumours. 7 There is sparse literature available on FNAC findings of granulosa cell tumour and FNAC findings of juvenile granulosa cell tumours of the ovary has not been described earlier. and loosely cohesive clusters of single population of cells with evidence of nuclear clefting and nuclear protrusion.…”

“…Fine‐needle aspiration cytology (FNAC) is a commonly used early investigation in children with abdominal mass in our institute as it is cost effective, non‐invasive and a rapid diagnostic procedure. Precise cytological diagnosis is important here as based on this, many of the patients receive specific pre‐operative chemotherapy regimen such as in case of Wilms tumour, neuroblastoma and germ cell tumours such as yolk sac tumours 7 . There is sparse literature available on FNAC findings of granulosa cell tumour and FNAC findings of juvenile granulosa cell tumours of the ovary has not been described earlier.…”

Cytological findings in a case of undifferentiated embryonal sarcoma of liver in a child: Report of a case with review of literature

“…3 Others are UES, hepatocellular adenoma, nested stromal epithelial tumour, Langerhans cell histiocytosis, etc. 4 Undifferentiated embryonal sarcoma is one of the rare types of malignant hepatic mesenchymal neoplasm. Embryonal sarcoma represents the third most common primary paediatric liver tumour after hepatoblastoma and hepatocellular carcinoma with estimated incidence of one case per million people per year.…”

“…Fine-needle aspiration is often used for the initial evaluation of paediatric patients presenting with abdominal masses and is the preferred method of investigation in our institute. 4 Cytologic mimics of UES include hepatoblastoma (HB) with predominance of mesenchymal elements, biliary tract rhabdomyosarcoma (RMS) and hepatocellular carcinoma. Differentiating these on cytology is important as most of these patients receive pre-operative chemotherapy.…”

Minimally Invasive Cytopathology and Accurate Diagnosis: Technical Procedures and Ancillary Techniques

“…CB is essential for the future of cytology; more output could be achieved with less material and with a low degree of invasiveness. Strong evidence indicates that the combination of conventional cytology and CB improves the diagnostic accuracy of endosonography with FNA (EUS-FNA) (57). This approach should be implemented in general practice, especially where rapid onsite evaluation (ROSE) is not available.…”