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Background An accurate recognition of a lymphoma at an extranodal site is essential to avoid unnecessary excisions. Fine needle aspiration cytology (FNAC) has been recognized as a useful tool in the primary diagnosis of soft tissue tumors. An anaplastic large cell lymphoma (ALCL), occurring in soft tissues, poses a diagnostic challenge. We present the cytomorphology of 2 cases of anaplastic lymphoma kinase (ALK) + ALCL that displayed a perivascular arrangement, thereby mimicking a sarcoma. Cases The patients were aged 16 and 9 years. While the former presented with multiple nodular soft tissue and bony lesions over the body, the latter complained of an axillary lump. FNAC smears in both cases showed pleomorphic cells, arranged in loosely cohesive groups around blood vessels and scattered singly, with prominent nucleoli and abundant, finely vacuolated cytoplasm. Interspersed were a few cells with embryoid nuclei. Differential diagnoses included a rhabdomyosarcoma and a lymphoma. On biopsy and immunohistochemistry, tumor cells were positive for vimentin, LCA, EMA, CD30 and ALK. Conclusion ALCL should be considered in the differential diagnosis of pediatric soft tissue tumors, especially in cases with multifocal involvement. The presence of cohesive, perivascular arrangements on FNAC should not detract a cytologist for keeping this possibility in mind. Further, a careful search for the typical "hallmark" cells should be made.

OBJECTIVE To evaluate accuracy and role of immunocytochemistry (ICC) in cytologic diagnosis of pediatric renal tumors. STUDY DESIGN Fine needle aspirates from 75 cases of pediatric renal tumors were studied. Radiologic-guided aspirations were performed, with 6-7 smears stained with Papanicolaou and Giemsa stains. Smears were screened without the knowledge of final histologic diagnosis. Subsequently, clinical details, final histology and diagnosis rendered by the original cytologist were noted to judge accuracy of diagnosis by a sensitized cytologist. Five neuroblastomas that entered close differentials for Wilms tumor were also evaluated. ICC studies were also performed after staining. RESULTS Of 58 Wilms tumors, 5 were misdiagnosed; 3 renal rhabdoid tumors and 1 clear cell sarcoma were missed on cytology. Non-Hodgkin's lymphomas presenting as renal masses were accurately diagnosed on cytology, but primitive neuroectodermal tumors (n = 3) and renal cell carcinomas (n = 2) were not accurately diagnosed. Accuracy rate improved from 65% to 92% on review by a cytologist aware of cytologic features of pediatric renal tumors. CONCLUSION A good accuracy rate of diagnosis of pediatric renal tumors can be achieved by priming pathologists to typical features of tumors. Immunocytochemistry plays a supportive role in cases with atypical morphology or unusual presentations.

Objective To elucidate the cytologic findings in simple trichilemmal (pilar) cysts and proliferating trichilemmal cysts (pilar tumors) and the clinical importance of these lesions. Study design Aspirates from 12 simple pilar cysts and three pilar tumors, all histologically confirmed, were analyzed with a view to elaborating on specific cytologic features enabling a distinction from epidermal cysts and other adnexal tumors. Results Aspirates from pilar cysts showed two different pictures, depending on the age of the cyst. Young pilar cysts showed aspirates with an abundant background of blotchy keratin with or without calcification and inflammation. Older (degenerating) cysts showed oily fluid debris with cholesterol crystals and inflammatory cells. The epithelial component was sparse, and only an occasional syncitial cluster of small squamoid cells was seen. As opposed to this, epidermal cysts usually showed a cleaner background, with very cellular aspirates containing many nucleate and anucleate squames, keratin flakes, platelike crystals and no calcification. The pilar tumors showed a lesser amount of keratin as compared to pilar cysts and yielded large and small clusters of squamoid and basaloid cells, a few of which showed an abrupt association with anucleate, keratinized globules. Conclusion The cytologic diagnosis of a pilar cyst should be made especially in scalp cysts, which yield either abundant, blotchy keratin or oily, cholesterol-rich debris with a sparse epithelial component and which lack a mixture of anucleate and nucleate squames. On aspiration, pilar tumors yield comparatively more cells and less keratin and show small, basaloid or squamoid cells abruptly associated with keratin globules. The cytologic diagnosis of pilar cysts is important because these cysts recur if incompletely excised and often undergo transformation to pilar tumors. Similarly, pilar tumors often clinically mimic squamous carcinomas, and hence there is a need to outline definitive cytologic features.

Background The definitive diagnosis of gout is best established by demonstration of monosodium urate (MSU) crystals in the synovial fluid or biopsy. Fine needle aspiration cytology (FNAC) of tophi can play a crucial role in diagnosis. Cases A 36-year-old chronic alcoholic male developed subcutaneous nodules on both malleoli without a history of arthropathy and with normal serum uric acid levels. FNAC of the nodules demonstrated stacks and sheaves of needle-shaped crystals of MSU. A 50-year-old diabetic male developed multiple nodules on the feet. He gave a past history of painful athropathy. A roentgenogram of the feet was suspicious for gout; however, joint aspiration failed, and the serum uric acid levels were normal. At this juncture FNAC of the feet tophi clinched the diagnosis of gout. In both cases, polarization of needle washings (wet mount) and the fixed, Papanicolaoustained smears showed negatively birefringent, needle-shaped crystals of MSU, thus confirming the diagnosis of gout. Conclusion FNAC of gouty tophi is an easy alternative to synovial biopsy and joint fluid analysis. It is simpler, easier and less painful. As crystals are preserved in stained smears, they can be employed for polarization and confirmation of gout.

Objective To analyze fine needle aspirates from tubular adenomas of the breast and elucidate cytologic features unique to these tumors. Study design Fine needle aspiration (FNA) cytology smears from eight tubular adenomas were reviewed, with special attention given to architectural features and individual cell characteristics. Smears were then compared with those from 25 fibroadenomas and 2 tubular carcinomas for analyzing the distinguishing features. Results Aspirates from tubular adenomas revealed cells arranged as small, three-dimensional balls or clusters, tubules of different shapes and less frequently as closely approximated acini. Cells were uniform, with pale cytoplasm, which showed magenta granules in the Giemsa smears from two tumors. Straight tubules, closely approximated acini and intracytoplasmic granules were not seen in aspirates from fibroadenomas. The tubules in tubular adenomas always showed myoepithelial cells and were more open than the angulated tubules of tubular carcinoma. Conclusion Tubular adenomas on FNA cytology specifically show cells arranged as small, three-dimensional balls, tubules or closely approximated acini. Cells are uniform and sometimes show intracytoplasmic granules in Giemsa-stained smears.