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Oncogenic (tumor-induced) osteomalacia is a rare paraneoplastic syndrome of phosphate wasting that is frequently associated with phosphaturic mesenchymal tumor (PMT). As the cytologic features of this tumor apparently have not been reported, we describe the fine-needle aspiration (FNA) findings for PMT that arose from the gluteal soft tissue in a patient with hypophosphatemia and multiple fractures secondary to osteomalacia. Smears from the computerized tomography (CT)-guided FNA showed groups of spindle cells having elongated nuclei, fine to moderately coarsely granular chromatin, inconspicuous nucleoli, and delicate cytoplasm. Marked nuclear atypia, mitotic figures, and necrosis were absent. The differential diagnosis included a variety of benign and malignant spindle cell neoplasms such as monophasic synovial sarcoma, leiomyoma, peripheral nerve sheath tumor, fibrosarcoma, and, less likely, metastatic melanoma and sarcomatoid carcinoma. The bland-appearing cytologic features of a spindle cell tumor in a patient with osteomalacia should suggest the diagnosis of PMT.

An unusual breast carcinoma with prominent spindle cells, intracytoplasmic mucin, and argyrophilia in an 82-yr-old woman was sampled preoperatively by fine-needle aspiration (FNA). The smears contained highly cellular sheets and fragments of uniform spindle cells with abundant vacuolated cytoplasm. The cells were mucicarmine positive and contained many cytoplasmic argyrophilic granules. The findings were confirmed by histologic examination of the excised tumor, which was also studied with a panel of immunohistochemical stains. A review of the literature indicated that spindle-cell argyrophilic mucin-producing carcinoma (SCAMPC) of the breast is a very rare neoplasm presenting primarily in elderly patients. The FNA cytologic features seem to be unique and should allow distinction from other primary breast lesions.

Leukemias and lymphomas involving the lung were diagnosed by means of exfoliative cytology in 31 specimens from 20 patients. Initial diagnostic categorizations included 29 specimens "positive for malignancy," including two thought to represent "carcinoma vs. lymphoma," and two considered suspicious for lymphoma. Previous diagnoses of lymphoma (13 patients) and acute myelogenous leukemia (AML) (2 patients) were available. In 5 additional patients, exfoliative respiratory cytology yielded the first diagnosis of hematopoietic malignancy. Cytologic diagnosis included nine large-cell and six small-cell non-Hodgkin's lymphomas (NHL), three Hodgkin's lymphomas (HD), and two AML. Key cytologic features included markedly pleomorphic and monomorphic cell populations in HD and NHL, respectively, as well as lack of tumor cell cohesion and necrosis in all cases. Cytologically, acute leukemia may be difficult to differentiate from large-cell NHL, and small-cell NHL from reactive/benign small lymphocytes. Blood, scant cellularity, crush artifacts, and apparent molding may affect diagnostic accuracy. Immunocytochemistry in cell block sections of sputa and washings is useful in the diagnostic workup in selected cases. Although involvement of the respiratory system by leukemias and lymphomas is uncommon and not always preceded by a history of malignancy, cytologic diagnosis is usually prompt, reliable, and accurate.

We reviewed the clinical and fine-needle aspiration (FNA) findings in 20 patients with poorly differentiated carcinomas presenting initially as parotid or as submandibular masses. There were 11 primary tumors and nine metastatic malignancies in 14 males and six females ranging in age from 39 to 89 yr (median = 66). The tumor types included three primary carcinomas with oncocytic features, three additional cases of high-grade parotid carcinoma, one case of primary neuroendocrine carcinoma, two examples of malignant mixed tumor, one high-grade mucoepidermoid carcinoma, and a single example of malignant lymphoepithelial lesion. Six patients with metastatic carcinoma had previous diagnoses of malignancy. In the three remaining individuals, primary carcinomas of the lung (two cases), and an unknown primary site presented initially as parotid masses. Five examples of metastatic squamous cell carcinoma, one metastatic basal cell carcinoma, and two metastatic renal cell carcinomas were identified. One parotid lymphoepithelioma was interpreted cytologically as an atypical lymphoproliferative process suggestive of Hodgkin's disease. Nineteen cases (95%) were correctly classified as carcinoma at the time of FNA. High-grade carcinomas aspirated from the parotid may be primary, but are frequently metastatic to either the gland, or to an intraparotid lymph node. Our experience indicates that some metastatic carcinomas present at this site, without a previous history of malignancy. Distinguishing primary from metastatic lesions has important therapeutic implications.

The interpretation of endocervical brush specimens requires familiarity with the various benign, atypical, dysplastic, and invasive neoplastic changes in cells located in the endocervical canal. There are several pitfalls in the cytologic evaluation of brush specimens that may result in diagnostic difficulty and error. We report seven cases of high-grade squamous intraepithelial lesions that were sampled by endocervical brushing and confirmed by cone biopsy or hysterectomy in which the cytologic changes in the Papanicolaou smears mimicked those of microinvasive squamous-cell carcinoma. The cells in the smears were compared with those in the tissue sections to determine their sites of origin. Results of this study indicate that cells with features fulfilling the criteria for microinvasive carcinoma were found primarily in brushing smears and corresponded with the features of cells involving the endocervical glands rather than those in the surface epithelium. We conclude that the criteria that have been promulgated for the cytologic diagnosis of microinvasive squamous-cell carcinoma have limited value in the examination of endocervical brush specimens.

Although the cytologic changes in cervical and vaginal squamous cells after radiation therapy were well-described decades ago, alterations in endocervical cells in response to radiation therapy have not been delineated in detail. We studied the effect of radiation therapy (usually combined linear accelerator beam and radium insertion) on endocervical cells as seen in endocervical brush specimens from 24 patients treated for cervical cancer. Of the 40 smears examined, 45 % were taken 3–6 mo after the completion of radiotherapy, 28% at 10–14 mo, and 20% at 18–34 mo. Endocervical cells appeared as single cells and in clusters and had lavender, mucin-filled cytoplasm. When present in clusters, they lacked the honeycomb appearance of normal endocervical cells. In smears taken at 3–6 mo. the majority of endocervical cells were enlarged (100% of smears) but they usually had normal nuclear/cytoplasmic ratios. Their nuclei were enlarged (100% of smears); varied in size (100%); had some coarse chromatin (67%) and large nucleoli (78%); and were multinucleated (89%). Repair cells and multinucleated histiocytes were seen in 83% and 61% of smears, respectively, Each of these cytologic findings was less apparent in follow-up smears taken more than 6 mo after the completion of radiation therapy. Awareness of these cytologic changes in endocervical cells after radiation therapy precludes the overdiagnosis of cancer in follow-up endocervical brush specimens.

The cytologic features of terminal duct carcinoma of the palate, as observed in a fine-needle aspiration specimen, are described and contrasted with the cytologic features reported for benign mixed tumor, basal-cell adenoma, and adenoid cystic carcinoma. Terminal duct carcinoma, at times, may be difficult, if not impossible, to distinguish from adenoid cystic carcinoma in fine-needle aspiration specimens. In most instances, this distinction may not be important.

The cytologic features of a multifocal adult rhabdomyoma of the head and neck, as observed in a fine-needle aspiration specimen, are described. Cross-striations and characteristic cytoplasmic "crystals" were conspicuous in the cytologic preparations and also during ultrastructural examination. The cytologic features of adult rhabdomyoma are distinctive, allowing a rapid specific diagnosis.