Diagnóstico citológico de las recidivas tumorales de ameloblastoma: presentación de dos casos clínicos

Introducción: Los ameloblastomas son los tumores odontogénicos más frecuentes del maxilar. A pesar de su aspecto citohistológico de benignidad, se comportan como tumores invasivos, recidivantes y con posibilidad de metastatizar. La P.A.A.F. es una prueba rápida e incruenta que proporciona un diagnóstico prequirúrgico evitando, en ocasiones, tomas biópsicas destinadas al diagnóstico. Presentamos las características citológicas de dos casos de recidiva yugal de ameloblastoma de rama mandibular diagnosticados por PAAF, así como su correlación citohistológica. Casos clínicos: Dos pacientes, una mujer de 36 años y un varón de 62 años, que acuden por tumoración mandibular de escasos meses de evolución. En ambos casos, la primera aproximación diagnóstica fue junto a los estudios radiológicos el estudio histológico de la masa tumoral. Tras la extirpación terapeútica, ambos casos recidivaron. El diagnóstico de las recidivas fue establecido citológicamente mediante PAAF. Las extensiones citológicas mostraron un fondo granular con aislados macrófagos y células multinucleadas gigantes y una abundante celularidad epitelial de aspecto basaloide dispuesta en grupos cohesivos configurando imágenes de empalizada periférica, así como pequeños grupos de células de metaplasia escamosa. Discusión: La PAAF se considera como un método diagnóstico rápido, incruento y fiable en el diagnóstico del ameloblastoma. La citología de estos tumores revela los componentes de la lesión que, en general, son suficientes para llegar al diagnóstico de ameloblastoma, especialmente en casos de recidiva.Introduction: Ameloblastomas are the most frequent odontogenic tumors of the maxilla. In spite of their benign cytohistological appearance, they behave as invasive recurring tumors, with the possibility of metastasis. FNAB is a rapid, bloodless test that provides a pre-surgical diagnosis, thus, on occasions avoiding the need for diagnostic biopsies. We present the cytological characteristics of two cases of jugal recurrences of mandibular ameloblastomas diagnosed by FNAB, as well as their cytohistological correlation. Clinical cases: Two patients, a 36-year-old woman, and a 62- year-old male who both attended with mandibular swelling of a few months evolution. In both cases the first diagnostic approximation was the histological study of the tumoral mass, together with the radiological studies. Following therapeutic extirpation both cases recurred. The diagnosis of the recurrences was established cytologically by means of FNAB. The cytologic smears revealed a granular background with isolated macrophages and giant multinucleate cells and an abundant epithelial cellularity of basaloid appearance arranged in cohesive groups forming images of peripheral palidasing, as well as small groups of squamous metaplastic cells. Discussion: FNAB is considered to be a rapid, bloodless and reliable method for the diagnosis of ameloblastoma. The cytology of these tumors reveals components of the lesion that, in general, are sufficient for the diagnosis of ameloblastoma, especially in cases of recurrence

Características citopatológicas del carcinoma de células acinares (CCA) de glándula salival: a propósito de cuatro observaciones

Objetivo: Presentar las características citopatológicas del carcinoma acinar (CCA), así como su correlación cito-histológica, comentando los problemas de diagnóstico diferencial de esta entidad en base a cuatro observaciones estudiadas mediante PAAF. Casos clínicos: Dos varones de 52 y 53 años, una mujer de 79 años, y una niña de 12 años que presentaron tumoraciones localizadas en territorio parotídeo (casos 1, 2 y 4), y a nivel laterocervical (caso 3). En tres pacientes, la PAAF fue, junto a los estudios de imagen, la primera aproximación diagnóstica; correspondiendo el caso 3 a una punción de adenopatías laterocervicales metastásicas en una paciente con antecedentes de CCA de parótida. Hallazgos citológicos: Las extensiones citológicas mostraron abundante celularidad tumoral dispuesta en pequeñas placas monocapa, formando estructuras acinares, o como células aisladas. Es de destacar la abundancia de núcleos desnudos en el fondo de los frotis, y la ausencia de grasa y de epitelio ductal. Las células poseían núcleos monomorfos redondeados u ovales, nucleólo poco evidente y abundante citoplasma granular o finamente vacuolado. Discusión: La PAAF proporciona información esencial en la actuación diagnóstico-terapeútica de las tumoraciones de la glándula salival, resultando esta metodología muy sensible en su eficacia diagnóstica. La identificación de los CCA frecuentemente presenta dificultades, debido a la gran similitud citológica de las células tumorales con el componente acinar normal propio de la glándula salival. El diagnóstico diferencial se plantea, fundamentalmente, con carcinomas de células claras, con carcinomas mucoepidermoides, con el tumor de Warthin y con los oncocitomas. Nuestras observaciones confirman la validez de la PAAF en una primera aproximación diagnóstica de estas lesiones tumorales accesibles a la punción directa.Objective: To present the cytopathological characteristics of acinic cell carcinoma (ACC) as well as its cyto-histological correlation, commenting on the differential diagnostic problems of this entity based on four observations studied using fine-needle aspiration biopsy (FNAB). Clinical Cases: Two males of 52 and 53 years of age, one 79 year-old woman and a girl of 12 years of age, who presented tumors located in the parotid area (cases 1, 2 and 4) and at the laterocervical level (case 3). In 3 patients, the FNAB was, together with the image studies, the first diagnostic indication; case 3 corresponding to a puncture of metastatic laterocervical adenopathies in a patient with a history of parotid ACC. Cytological findings: The cytologic smears revealed abundant tumoral cellularity arranged in small monolayered sheets, forming acinar structures or isolated cells. The abundance of bare nuclei at the background of the smears, and the absence of adipose tissue and ductal epithelium are highlighted. The cells possessed round or oval monomorphic nuclei, few nucleoli and abundant granular or finely vacuolate cytoplasm. Discussion: FNAB provides essential information on the diagnostic- therapeutic management of salivary gland tumors; this methodology is highly sensitive in its diagnostic efficacy. The diagnosis of ACCs frequently presents difficulties, owing to the great cytologic similarity of the tumor cells with the normal acinar component of the salivary gland. The differential diag-nosis is considered, fundamentally, with clear cell carcinomas, mucoepidermoid carcinomas, Warthin's tumor, and oncocytomas. Our observations confirm the validity of FNAB in a first diagnostic approximation for those lesions accessible to direct puncture

Thyroid papillary carcinoma infarction after fine needle aspiration

Complications following fine needle aspiration (FNA) are very infrequent and generally resolve spontaneously without treatment. The appearance of necrosis or infarction after FNA of the thyroid gland is an exceptional finding. An 83-year-old woman with a thyroid nodule was subjected to diagnostic FNA using a G23 needle. The patient noted a decrease in nodule size after FNA. A total thyroidectomy was performed 36 days after FNA. The cytological diagnosis was papillary carcinoma. Histology revealed massive coagulation necrosis affecting 80% of the tumor mass; the cytological diagnosis was confirmed. Iron pigment deposits were observed in the vicinity of the necrotic areas together with interstitial fibrosis; this suggested a mechanism of ischemic necrosis but no vascular thrombosis was observed. Post-FNA tumour regression of a thyroid lesion is an infrequent finding thet should be made known to clinicians and pathologist, since final diagnosis may be difficult by the massive necrosis

Aplicacion de la PAAF en el diagnostico de masas mediastinicas. Correlación cito-histologica

Fine needle aspiration (FNA) is found to be a useful and non invasive technique in the presurgical diagnosis of intrathoracic masses. In the present study we report our findings from a total of 33 mediastinal aspiration punctures, performed over the past 24 months. In 24 of the 33 puntures, the lesion was either previously biopsied or surgically removed, which allowed for the corresponding cytohistological correlations. The cytological diagnosis demonstrated 12 cases of malignancy, 2 cases of benign lesions and 5 cases of negative tumours. It was possible to establish the cellular lineage in only 8 cases without specifying the benignity or malignancy of the lesion (2 neural tumours, 2 thymomas, 2 spindle cell mesenchymall tumours and 2 with a lymphoproliferative process), while 6 cases were insufficient for diagnosis. The sensitivity and specificity obtained using this diagnostic methodology was 79% and 100% respectively, where the diagnostic accuracy was 83%. The positive and negative predictive value was 100% and 53% respectively. In 2 of the 9 cases that were not operated on, the cytological diagnosis was benign, showing 2 brochogenic cysts that were evacuated during the process thus resolving the situation. Our findings and the adequate cytohistological correlation obtained confirm the effectiveness of FNA in the diagnosis of mediastinal masses