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Diagnostic Pitfall (diagnostic + pitfall)
Kinds of Diagnostic Pitfall Selected Abstracts5 DIAGNOSTIC PITFALLS IN THE ECHOCARDIOGRAPHIC EVALUATION OF HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM) REFERRED FOR CATHETER INTERVENTIONAL THERAPYECHOCARDIOGRAPHY, Issue 1 2004G. Beer Introduction: Generally, the diagnosis of typical HOCM with subaortic obstruction and a dynamic pressure gradient across the left ventricular outflow tract is made by noninvasive diagnostic procedures with great certainty by employing transthoracic (TTE) and/or transoesophageal (TEE) echocardiography. However, in patients with asymmetric septal hypertrophy pitfalls in echocardiographic examination may arise from several additional diseases as described in casuistic reports. To date systematic investigations in patients referred for catheter interventional therapy of HOCM are lacking. Patients and Methods: Therefore we investigated for the first time in a systematic study 200 symptomatic patients. (180 consecutive and 20 nonconsecutive patients; functional class 3 or 4 according to NYHA) with HOCM who were referred for this new catheter interventional therapy. In all patients TTE, bicycle exercise Doppler echocardiography and multiplane TEE were performed. Results: In 4 of 180 consecutive patients. (2.2%) discrete subvalvular membranous aortic stenosis (DSAS) (3 female patients and 1 male patient; age 20 to 58 years; mean septal diameter 19 mm; Sam-like motion in all 4 patients) was made. In all cases the diagnosis could be confirmed by surgical treatment. TEE evaluation was of crucial importance with demonstration of a typical subvalvular membrane that was situated a few millimeters below the aortic valve. In all cases a typical asymmetric septal hypertrophy mimicking HOCM was seen. Additionally, in 2 patients there was a conincidence of severe symptomatic valvular aortic stenosis and HOCM and in 1 patient a tunnel type of subvalvular aortic stenosis was present. Conclusion: These results show the potential pitfalls in echocardiographic diagnosis of HOCM. Especially, the frequency of DSAS in symptomatic patients referred for HOCM is unexpectedly high (2.2%). Especially in patients in whom TTE is of insufficient quality, investigation employing multiplane TEE with careful evaluation of the small poststenotic subvalvular area in HOCM is of crucial importance. This is of special significance prior to catheter interventional therapy, because in these patients surgical treatment is mandatory. [source] Focal Regression-Like Changes in Dysplastic Back Nevi :A Diagnostic Pitfall for Malignant MelanomaJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005A. Hassanein Regression in melanoma can be complete or partial. Melanocytic nevi may show focal regression-like changes (RLC). We studied the incidence of RLC in a total of 777 melanocytic back nevi. These included 17 cases of blue nevi, 28 cases of compound nevi, 385 cases of compound dysplastic nevi, 34 cases of congenital compound nevi, 26 cases of congenital intradermal nevi, 58 cases of intradermal nevi, and 229 cases of junctional dysplastic nevi. The dysplastic nevi were categorised according to the associated cytologic atypia (mild, moderate, and severe). 21 malignant melanomas of the back were also reviewed for regression. RLC were seen with a striking correlation with the degree of cytologic atypia in dysplastic nevi. RLC were seen in 4.5% of mildly, 9.6% of moderately, and 17.2% of severely dysplastic compound nevi. RLC were seen in 10.3% of mildly, 18.8% of moderately, and 39.3% of severely dysplastic junctional nevi. The incidence of regression in non-dysplastic nevi was much less, ranging from 2.9% to 3.6%. We believe this phenomenon is probably related to trauma/irritation. Caution should be taken before rendering the diagnosis of regressed malignant melanoma on the back since dysplastic nevi may show focal similar changes. [source] Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 casesCYTOPATHOLOGY, Issue 2 2009A. N. Haberal Objectives:, Fine needle aspiration cytology (FNAC) of the thyroid is a non-invasive, cost-effective screening procedure that is valuable for distinguishing neoplastic lesions from non-neoplastic nodules. The aim of this study was to determine the diagnostic accuracy of FNACs performed at our institution by correlating FNAC results with histopathological diagnoses. Methods:, Two hundred and seventy-one aspiration cytology specimens followed by thyroidectomy were included in the study, and the results of 260 adequate FNACs were compared with their histological diagnoses. Results:, The sensitivity and specificity of thyroid FNAC for detecting neoplasia were 92.6% and 91.6%, respectively. There were 15 (5.7%) false positives and six (2.3%) false negatives. Conclusions:, The results showed that follicular cells that exhibit some of the features of papillary carcinoma could be observed in a cytology slide of Hashimoto's thyroiditis, leading to a diagnostic pitfall. In addition, cellularity and overlapping cytological criteria in hyperplasia might lead to a false diagnosis. [source] Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature reviewDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2010Akihiko Kawahara C.T., C.M.I.A.C., Ph.D. Abstract Cystadenocarcinoma is a rare malignant tumor, with an estimated incidence of 2% of malignant salivary gland tumors. Cytological diagnosis of cystadenocarcinoma is important for differential diagnosis between benign lesions and malignant tumors with cystic growth. We report a case of cystadenocarcinoma causing difficulty in cytological diagnosis. A 23-year-old man presented with an asymptomatic mass in the left parotid gland that had been present for 2 years. The mass was elastic hard, measuring 30 × 35 mm in diameter. Preoperative fine-needle aspiration cytology (FNAC) showed a small number of tumor cell clusters in the cystic fluid. The cluster was arranged in a ball-like structure and was cohesive with overlapping. Tumor cells had a small vacuolated, soap-bubble appearance in the cytoplasm. The papillary-cystic variant of acinic cell carcinoma (ACC-PCV) was suggested from these findings on FNAC. Histologically, the tumor was not encapsulated, but formed large cystic spaces against a background of fibrous connective tissue. The tumor cells in the cystic dilated duct showed papillary structures, which were continuous with the lining cuboidal cells. There was neither a definite double-layered arrangement in cystic ducts and solid islands nor histological findings characteristic of the papillary-cystic or follicular pattern of ACC-PCV. As tumor cells with a small vacuolated, soap-bubble appearance of the cytoplasm are common findings of both cystadenocarcinoma and ACC-PCV, they are of little use for differentiation; however, they are so characteristic that the majority of benign salivary gland lesions with cystic structures can be excluded, if enough attention is paid. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Fine-needle aspiration cytology of salivary glands: Diagnostic pitfalls,revisitedDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2006Arvind Rajwanshi M.D., F.R.C.Path. Abstract Fine needle aspiration cytology (FNAC) of salivary gland lesions is a safe, effective diagnostic technique. Several amply illustrated reviews are available in the English literature. The reported diagnostic accuracy varies between 86% to 98%. The sensitivity ranges from 62% to 97.6% and specificity is higher from 94.3% to 100%. In this present study, we have analyzed 172 cases of salivary gland aspirates and the histopathological diagnosis was available in 45 cases. There was discordance in cytological and histopathological diagnosis in nine cases. Five cases had discrepancies in benign versus malignant diagnosis with four cases being false negative. The errors in these FNA diagnoses were due to sampling error, observational error and interpretational error. Therefore, this study illustrates high diagnostic accuracy of FNAC in salivary gland lesions and shows that FNAC offers valuable information that allows the planning of subsequent patient management. Diagn. Cytopathol. 2006;34:580,584. © 2006 Wiley-Liss, Inc. [source] Acute monoblastic leukemia with abnormal granules and disseminated intravascular coagulation: Diagnostic pitfalls,AMERICAN JOURNAL OF HEMATOLOGY, Issue 11 2009Rebecca Pohlmann No abstract is available for this article. [source] Diagnostic pitfalls in children with sleep disorders: two cases with hypersomniaACTA PAEDIATRICA, Issue 12 2008Kutluhan Yilmaz Abstract Sleep disorders are common in children, yet several clinical pitfalls give rise to the unrecognition or improper management of those children. Here, we present diagnostic difficulties in two adolescents with narcolepsy and Kleine,Levin syndrome. The first patient was a 12-year-old girl who had been given Na-valproate for nearly a year because hypersomnia was initially perceived as unconsciousness periods of epileptic spells, and later attributed to the antiepileptic drug. The other patient was a 14-year-old boy who had been managed as a specific psychiatric disorder for several months despite the characteristic symptoms of Kleine,Levin syndrome (hypersomnia, hyperphagia, hypersexuality, behavioural and cognitive dysfunction). Both cases emphasize that sleep disorders could be manifested with various clinics and that there are several diagnostic challenges in children. Conclusion: Sleep medicine needs to be given larger role in both training curriculum and post-graduate education for paediatricians. [source] Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 casesCYTOPATHOLOGY, Issue 2 2009A. N. Haberal Objectives:, Fine needle aspiration cytology (FNAC) of the thyroid is a non-invasive, cost-effective screening procedure that is valuable for distinguishing neoplastic lesions from non-neoplastic nodules. The aim of this study was to determine the diagnostic accuracy of FNACs performed at our institution by correlating FNAC results with histopathological diagnoses. Methods:, Two hundred and seventy-one aspiration cytology specimens followed by thyroidectomy were included in the study, and the results of 260 adequate FNACs were compared with their histological diagnoses. Results:, The sensitivity and specificity of thyroid FNAC for detecting neoplasia were 92.6% and 91.6%, respectively. There were 15 (5.7%) false positives and six (2.3%) false negatives. Conclusions:, The results showed that follicular cells that exhibit some of the features of papillary carcinoma could be observed in a cytology slide of Hashimoto's thyroiditis, leading to a diagnostic pitfall. In addition, cellularity and overlapping cytological criteria in hyperplasia might lead to a false diagnosis. [source] Mandibular osteosarcoma: a diagnostic pitfall on aspiration cytology of the salivary glandsCYTOPATHOLOGY, Issue 2 2009Y. Daneshbod First page of article [source] Pilomatrixoma: a potential diagnostic pitfall in aspiration cytologyCYTOPATHOLOGY, Issue 4 2007S. Singh No abstract is available for this article. [source] Respiratory cytology: Differential diagnosis and pitfallsDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010F.R.C.P.C., Ph.D., Reda S. Saad M.D. Abstract Pulmonary cytology can be challenging and has its share of diagnostic pitfalls. Reactive atypia can occasionally be alarming, leading to diagnostic pitfall for a false-positive diagnosis of malignancy, even for experienced cytopathologists (Naryshkin and Young, Diagn Cytopathol 1993;9:89,97). In addition, cytologic preparations can show an absence of architectural clues, leading to diagnostic difficulties. Some conditions can cytologically as well as clinically and radiographically mimic malignancies, making these pitfalls even more frequent (Bedrossian et al., Lab Med 1983;14:86,95). A recent report stated that "no laboratory that aims to make definitive diagnoses in pulmonary cytology can be spared from false-positive results"(Policarpio-Nicolas and Wick, Diagn Cytopathol 2008;36:13,19). A false-positive finding could produce unnecessary treatment and morbidity, whereas false-negative diagnosis could result in delayed diagnosis and treatment. This review analyzes and illustrates cellular changes and benign entities that can mimic malignancy in respiratory cytology as well as neoplasms that could lead to a false-negative diagnosis. In addition, some specific challenging and difficult aspects in classification of pulmonary malignancies will be discussed. Guidelines and clues are presented to avoid such pitfalls. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Epithelioid angiosarcoma: A neoplasm with potential diagnostic challengesDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2010Christine F. Lin B.S. (Student) Abstract Epithelioid angiosarcomas are extremely rare tumors associated with poor prognosis and early metastases. Its epithelioid cytomorphology and limited vasoformation make it difficult to distinguish from more common malignancies, such as, carcinoma. This can be a potential diagnostic pitfall for the cytopathologist. In this report, the patient is a 24-year-old man presenting with testicular pain, a pelvic mass, and innumerable liver nodules. Immediate interpretation of the needle core biopsies of the pelvic mass and liver lesions initially favored a poorly differentiated adenocarcinoma. Unusual positive immunohistochemical stains for CD30 and CK7 ultimately led the investigation toward a tumor of mesenchymal origin. Further, immunohistochemical evaluation demonstrated positive CD31 and Factor VIII staining and established the final diagnosis of epithelioid angiosarcoma. The tumor cells were negative for CD34, CK20, alpha-fetoprotein, placental-like alkaline phosphatase, hepatocyte paraffin 1, polyclonal carcinoembryonic antigen, CD10, CA-125, prostate-specific antigen, and prostatic acid phosphatase. This case is reported to illustrate the importance of considering the diagnosis of epithelioid angiosarcoma when encountering an "epithelioid" neoplasm particularly with unusual immunoreactivity for CK7 and CD30. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Mycobacterium avium complex infection in a neck abscess: A diagnostic pitfall in fine-needle aspiration biopsy of head and neck lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2009Valerie A. Fitzhugh M.D. Abstract Fine-needle aspiration biopsy (FNAB) is a useful tool in the diagnosis of mycobacterial disease, especially Mycobacterium tuberculosis. However, nontuberculous mycobacterial infection diagnosed with FNAB material is much rarer, with Mycobacterium avium complex being the most common. In this report, we present the case of a 21-year-old HIV positive man, who presented with a unilateral, tender, enlarging cervical neck mass. FNAB had revealed acute inflammation. Mycobacterium avium complex grew in culture from the material that was aspirated and was confirmed by DNA probe. Because of the paucity of articles on this subject in the cytology literature, it is important to reiterate the value of the material aspirated at the bedside and the clinic in the diagnosis of infectious disease. When faced with antibiotic-resistant cellulitis and abscesses, the FNAB material must be sent for acid fast bacteria smears and culture. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Pleomorphic adenoma with predominant plasmocytoid myoepithelial cells: A diagnostic pitfall in aspiration cytology.DIAGNOSTIC CYTOPATHOLOGY, Issue 1 2009Case report, review of the literature Abstract Fine-needle aspiration (FNA) biopsy of the salivary gland is a sensitive and specific diagnostic tool. However, diagnostic problems are sometimes encountered in interpreting some cases, not only in differentiating benign from malignant cases but also in the specific classification of these neoplasms. We report a case of a pleomorphic adenoma with predominant plasmocytoid myoepithelial cells arising in minor salivary glands from the hard palate in a 78-year-old patient, which was falsely diagnosed as a carcinoma on liquid-based cytology (ThinPrep (TP)). The differential diagnosis of salivary gland tumors with predominant myoepithelial cells on FNA biopsy is discussed. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source] Myxoid liposarcoma of the breast in a 25-year-old female as a diagnostic pitfall in fine needle aspiration cytology: Report of a rare caseDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2008Ishita Pant M.D. Abstract Primary sarcomas of the breast are extremely rare comprising less than 1.0% of all malignant tumors of the breast. It is even rarer to be reported in a 25-year-old female. This can cause a diagnostic dilemma not only for the clinician but also for the cytopathologist. A 25-year-old woman presented with a well defined firm, mobile lump in her right breast. With fine needle aspiration cytology (FNAC) and ultrasonography a diagnosis of fibroadenoma was made. The patient underwent lumpectomy. Histopathologically it was diagnosed as myxoid liposarcoma. This case is reported to highlight the fact that, even though rare in young females but the possibility of a breast lump being a myxoid liposarcoma does exist. This report discusses a primary myxoid liposarcoma of female breast, considers cytologic differential diagnoses with review of the relevant literature. Diagn. Cytopathol. 2008;36:674,677. © 2008 Wiley-Liss, Inc. [source] Adenocarcinoma in colonic brushing cytology: High-grade dysplasia as a diagnostic pitfallDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2001Gordon H. Yu M.D. Abstract Cytologic evaluation of brushing specimens obtained from the colon may be useful in the diagnosis of neoplastic and inflammatory lesions, as previous studies have reported favorable sensitivity and specificity figures for this procedure. In this study, we report our experience with 80 colonic brushings examined over a 5-yr period. Thirty cases received an atypical or malignant cytologic diagnosis. Nineteen of 20 cases diagnosed cytologically as adenocarcinoma revealed adenocarcinoma on biopsy; one case showed only adenomatous epithelium on biopsy and subsequent resection. Cases diagnosed cytologically as "atypical" or "adenomatous" showed adenocarcinoma, adenoma, and inflammatory conditions upon biopsy. Slides from 30 atypical/malignant cases were retrospectively reviewed for a number of cytomorphologic features and were correlated with the histologic diagnosis. Cases from histologically confirmed adenocarcinoma tended to show greater degrees of altered nuclear polarity, nuclear pleomorphism, membrane irregularities, and chromatin pattern alterations than those from histologically proven adenomatous or inflammatory lesions. The most likely cause of a false-positive diagnosis in this setting is sampling of an adenoma with high-grade dysplasia which fails to meet histologic criteria for adenocarcinoma (invasion of the underlying muscularis mucosae). Thus, in the second part of the study, we examined histologic sections from surgically excised adenomas to determine the frequency with which profound nuclear atypia is at least focally present, potentially resulting in a false-positive cytology diagnosis upon brushing. Slides from 51 cases were reviewed; cytologic atypia beyond that typically observed in adenomas was not observed in 43% of cases. However, profound nuclear atypia was present in 6% of cases; cytologic evaluation of a brushing specimen from these lesions may have resulted in a false-positive diagnosis of adenocarcinoma, despite the histologic diagnosis of adenoma with severe dysplasia. The remaining cases demonstrated intermediate degrees of atypia. These findings serve to quantitate the frequency with which cytohistologic discrepancies might be expected for mass lesions of the colon. Diagn. Cytopathol. 24:364,368, 2001. © 2001 Wiley-Liss, Inc. [source] Multicentric giant cell tumours in an adolescent with haemophiliaHAEMOPHILIA, Issue 2 2007C.-C. CHANG Summary., ,,Multicentric giant cell tumour (GCTs) of the extremity is prone to be distributed over the age range of 20,40 years, but is rare in haemophilia and in the age before 20. We report a case of a 15-year-old haemophilia boy who presented initially with two radiolucent loci in the right femur and tibia revealed from the X-ray films and then another lesion in the posterior femoral shaft shown from MRI by one year. Differential diagnosis of GCTs should be appraised in various aspects. Radiological diagnostic pitfall was avoided by the pathology disclosed GCTs without malignancy. The early diagnosis of GCTs in haemophilia may be delayed unless appearance of symptoms of pathologic fracture. Coincident multicentric GCTs do occur in haemophilic patients and their incidence might be underestimated, as it might not be judged because immediate symptoms of pain would resolve with appropriate factor replacement." [source] Squamous metaplasia of the peritoneum: a potential diagnostic pitfallHISTOPATHOLOGY, Issue 6 2004N Mourra No abstract is available for this article. [source] Intra-abdominal sequestration of the lung and elevated serum levels of CA 19-9: a diagnostic pitfallHPB, Issue 1 2004C Armbruster Background Extralobar pulmonary sequestration is an uncommon congenital abnormality that is rarely diagnosed after the age of 40 years. We describe a 64-year-old woman with an intra-abdominal sequestration of the lung and elevated carbohydrate antigen (CA) 19-9 serum levels. Case outline On abdominal ultrasound a semi-solid cystic tumour was demonstrated that showed tight connection to the tail of the pancreas according to computed tomography. Cytological examination of the percutaneous biopsy did not lead to a definitive diagnosis. CA 19-9 serum levels were repeatedly elevated >250 IU/ml. With a tentative diagnosis of a tumour of the tail of pancreas the semi-solid cystic mass was resected. Frozen section histology suggested the diagnosis of pulmonary sequestration, which was confirmed by definitive histological examination. Immunohistochemical staining of the specimen with a specific monoclonal antibody against CA 19-9 showed strong immunoreactivity. Three months later the elevated CA 19-9 serum levels returned to normal. Discussion Elevated CA 19-9 serum levels have been described in benign pulmonary and mediastinal cystic lesions and in one case of extralobar intrathoracic lung sequestration. Although there is evidence that malignancies may arise in congenital lung cysts, CA 19-9 serum levels have not been investigated in such cases. Based on our results elevated serum values of CA 19-9 in combination with a cystic semi-solid mass in the left subphrenic space should include the differential diagnosis of extralobar pulmonary sequestration. [source] Liesegang rings in an apocrine hidrocystoma: a case report and review of literatureJOURNAL OF CUTANEOUS PATHOLOGY, Issue 10 2010Heidi M. Gilchrist Liesegang rings represent an in vivo chemical precipitation phenomenon representing a potential diagnostic pitfall for misdiagnosis as parasitic infections. These acellular patterns of lamellar concretions are rare in human tissue. The authors report a case of Liesegang rings observed within an intradermal apocrine hidrocystoma and review the literature for reports of these structures, with particular emphasis on mucocutaneous lesions. Gilchrist HM, Wick MR, Patterson JW. Liesegang rings in an apocrine hidrocystoma. [source] Atypical intravascular CD30+ T-cell proliferation following trauma in a healthy 17-year-old male: first reported case of a potential diagnostic pitfall and literature reviewJOURNAL OF CUTANEOUS PATHOLOGY, Issue 3 2009Christian L. Baum Herein, we present the first report of a reactive atypical intravascular CD30+ T-cell proliferation. Our patient developed the condition after trauma, and he has followed a benign clinical course. This observation represents a potential diagnostic pitfall for intravascular lymphoma and adds to the list of reactive conditions that may be associated with an atypical CD30+ T-cell infiltrate. [source] Squamous cell carcinomas with single cell infiltration: a potential diagnostic pitfall and the utility of MNF116 and p63JOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2008Christine J. Ko Numerous variants of squamous cell carcinoma (SCC) have been described. We recently encountered four examples of SCC composed primarily of single, atypical cells that were cytokeratin (CK) MNF116-positive and p63-positive. One case was particularly difficult to diagnose as the single cells were obscured by a dense inflammatory infiltrate. We have also noted similar single cell infiltration toward the periphery of four additional cases of more typical SCC. These foci resemble the single tumor cells that may infiltrate at the borders of spindle cell and desmoplastic SCCs. CK MNF116 and p63 were useful in identifying each of these neoplasms. This single , cell pattern of SCC can easily be misdiagnosed, and CK MNF116 and/or p63 are diagnostically helpful in recognizing it. [source] An unusual nodal marginal zone lymphoma with bright CD10 expression: A potential diagnostic pitfall,AMERICAN JOURNAL OF HEMATOLOGY, Issue 7 2010Endi Wang No abstract is available for this article. [source] Immunohistochemical detection of cytokeratin and epithelial membrane antigen in leiomyosarcoma: A systematic study of 100 casesPATHOLOGY INTERNATIONAL, Issue 1 2000Jun Iwata Although ,aberrant' expression of the epithelial markers, cytokeratin (CK) and epithelial membrane antigen (EMA), in leiomyosarcoma has been described previously, there has not been a study of this phenomenon with clinicopathological correlation in a large series of lesions at different anatomical sites. We investigated systematically the immunohistochemical reactivity for CK and EMA in 100 cases of leiomyosarcoma. CK and EMA were positive in 38% and 44% of the cases, respectively. Although staining was usually focal, extensive immunoreactivity was observed in 11% with CK and 6% with EMA. There was no correlation between immunoreactivity for CK and EMA in leiomyosarcomas and non-neoplastic smooth muscle at the same location. Immunoreactivity for CK and EMA was not correlated with the location, age, sex, histological grade, or histological features, except for more frequent EMA positivity in vascular and uterine tumors than in soft tissue cases. These results indicate that CK and/or EMA-positive leiomyosarcomas do not have distinctive clinicopathological features differing from those of negative cases. However, the considerable frequency of immunoreactivity for these epithelial markers in leiomyosarcoma, occasionally with diffuse and strong immunopositivity, should be recognized as a potentially serious diagnostic pitfall in the differential diagnosis of other malignant spindle cell neoplasms. [source] Medallion-like dermal dendrocyte hamartoma: the main diagnostic pitfall is congenital atrophic dermatofibrosarcomaBRITISH JOURNAL OF DERMATOLOGY, Issue 1 2009M. Marque Summary Medallion-like dermal dendrocyte hamartoma is a newly described and rare clinical and pathological entity. This congenital, round, erythematous and atrophic lesion in the thoracic area is histologically characterized by a CD34+ dermal and hypodermal spindle-cell infiltration. We describe the clinical, histopathological, cytological and molecular features of three cases of dermal dendrocyte hamartoma. In all the cases, atrophic congenital dermatofibrosarcoma protuberans (DFSP) was the first histological diagnosis. In one case, wide surgery had been performed on the basis of the clinical and histological presentation. The histological pattern was similar in all the cases: epidermal atrophy and a spindle to ovoid cell proliferation in the dermis and in the subcutaneous fat. Immunochemical staining for CD34 and factor XIIIa was positive. Cytogenetic and molecular studies were performed; no chromosomal abnormality nor translocation t(17;22)(q22;q13) was observed. Fluorescence in situ hybridization analysis did not reveal the DFSP fusion gene COL1A1-PDGFB. We observed that the main diagnostic pitfall of medallion-like dermal dendrocyte hamartoma is atrophic congenital DFSP due to clinical and histological similarities. We emphasize that molecular studies to eliminate the t(17;22)(q22;q13) translocation of DFSP may provide determinant elements for diagnosis in order to avoid unnecessary mutilating surgery. [source] Pitfalls in fine needle aspiration cytology,CYTOPATHOLOGY, Issue 4 2003Svante R. OrellArticle first published online: 22 JUL 200 A review of pitfalls encountered in fine needle aspiration cytology (FNAC) of all organs and tissues and based mainly on the author's 35-year experience of diagnostic FNAC in clinical practice is presented. Diagnostic difficulties are usually related to deviations from common cytological criteria that may occur in some lesions. Others are due to the effects of the sampling procedure or of the preparation of samples. A few basic rules are proposed, which may help to avoid some of the diagnostic pitfalls. [source] Sarcomatoid collecting duct carcinoma of kidney diagnosed with urine and renal pelvic lavage cytologyDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2010Akihiro Mimura C.T. Abstract A case of sarcomatoid collecting duct carcinoma (CDC) of kidney is presented, in which the diagnosis was made cytologically with voided urine and renal pelvis lavage. Cytology of hemorrhagic voided urine revealed highly atypical adenocarcinoma cells with reminiscent ductal structure, which suggested CDC as the most likely diagnosis. Computed tomography and magnetic resonance imaging demonstrated a left renal tumor, and selective lavage of left renal pelvis yielded spindle-shaped, highly atypical cells that indicated sarcomatoid carcinoma. The diagnosis of renal cancer with urine cytology is challenging because of small number of tumor cells in the urine, which are often associated with degeneration. As the urinary cytologic findings of sarcomatoid CDC have not been reported, the characteristic cytologic findings of sarcomatoid CDC are described in detail, and the differential diagnoses with diagnostic pitfalls were discussed. Diagn. Cytopathol. 2010;38:603,606. 2009 Wiley-Liss, Inc. [source] Respiratory cytology: Differential diagnosis and pitfallsDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010F.R.C.P.C., Ph.D., Reda S. Saad M.D. Abstract Pulmonary cytology can be challenging and has its share of diagnostic pitfalls. Reactive atypia can occasionally be alarming, leading to diagnostic pitfall for a false-positive diagnosis of malignancy, even for experienced cytopathologists (Naryshkin and Young, Diagn Cytopathol 1993;9:89,97). In addition, cytologic preparations can show an absence of architectural clues, leading to diagnostic difficulties. Some conditions can cytologically as well as clinically and radiographically mimic malignancies, making these pitfalls even more frequent (Bedrossian et al., Lab Med 1983;14:86,95). A recent report stated that "no laboratory that aims to make definitive diagnoses in pulmonary cytology can be spared from false-positive results"(Policarpio-Nicolas and Wick, Diagn Cytopathol 2008;36:13,19). A false-positive finding could produce unnecessary treatment and morbidity, whereas false-negative diagnosis could result in delayed diagnosis and treatment. This review analyzes and illustrates cellular changes and benign entities that can mimic malignancy in respiratory cytology as well as neoplasms that could lead to a false-negative diagnosis. In addition, some specific challenging and difficult aspects in classification of pulmonary malignancies will be discussed. Guidelines and clues are presented to avoid such pitfalls. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Pleomorphic adenoma: Cytologic variations and potential diagnostic pitfallsDIAGNOSTIC CYTOPATHOLOGY, Issue 1 2009Uma Handa M.D. Abstract The diverse morphological features encountered in pleomorphic adenoma (PA) may cause diagnostic errors in fine needle aspiration cytology (FNAC). The present study was performed to evaluate the variations in the cytological features of pleomorphic adenoma and to assess the efficacy of FNAC in its diagnosis. Fifty cases diagnosed as PA on FNAC were retrieved from the records of the Pathology Department. Cytologic smears and sections were reviewed and the cytologic diagnoses were compared with the definitive histologic diagnoses. In cases correctly diagnosed on aspiration, morphological variables like patterns of the epithelial component, type and extent of the mesenchymal matrix, metaplastic cells, hyaline globules, cystic change, giant cells, crystalline deposits, nuclear inclusions/grooves, and nuclear atypia were evaluated. The extreme diversity in morphologic features seen in histologic sections was reflected in the smears of PA. Metaplastic changes were observed more frequently in sections, while nuclear changes like inclusions/grooves were more commonly seen in smears. Other morphological features like cylindromatous pattern, giant cells and crystalline deposits were observed with equal frequency in smears and sections. Cytohistologic agreement was present in 45 of the 50 cases (90%). In 5 cases diagnosed as pleomorphic adenoma on FNAC, the histology revealed 1 case each of schwannoma, perineurioma, ectomesenchymal chondromyxoid tumor of tongue, adenoid cystic carcinoma and mucoepidermoid carcinoma. FNAC is a fairly accurate pre-operative procedure for the diagnosis of PA. The cytopathologist needs to be aware of the cytologic variations in pleomorphic adenoma so as to avoid diagnostic errors. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source] Fine-needle aspiration cytology of basal cell adenoma of the parotid gland: Characteristic cytological features and diagnostic pitfallsDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2007Akihiko Kawahara C.T., Ph.D. C.M.I.A.C. Abstract We retrospectively studied the cytological features of aspiration cytology in 12 cases of basal cell adenoma (BCA) and 5 cases mistakenly diagnosed as BCA. On macroscopic findings, the 12 cases of BCA included 7 cases of solid type and 5 cases of cystic type. The characteristic cytological features of solid type BCA were three-dimensional clusters in 71%, sharp-angle small clusters in 86%, basement membrane- like material in 71%, and cell crush in 86%. In contrast, 3 of the 5 cystic type BCA cases showed inadequate cellular components or no basaloid tumor cells, and the cytological diagnosis of BCA could not be determined. In the 5 cases misdiagnosed as BCA, there were 2 cases of pleomorphic adenoma, 2 cases of benign lymphoepithelial cyst, and 1 case of basal cell adenocarcinoma. Accurate differential cytological diagnosis of BCA is relatively easy to determine the solid type BCA, but is more difficult for cystic type BCA. Diagn. Cytopathol. 2007;35:85,90. © 2007 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||