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Context: Beyond squamous carcinoma, a variety of diagnostically challenging neoplasms arise within various head and neck sites. This is particularly the situation with neoplasms where little cellular cytoplasm is present to assist the pathologist in categorizing such lesions., Objective: To highlight diagnostic pitfalls that accompanying neoplasms composed primarily of 'cytoplasmically-poor' cells. These pitfalls include morphologic and immunohistochemical traps that emerge from this class of neoplasms., Data Sources: Selection of pathologic specimens from the author's personal files, and literature review., Conclusions: Interpretative pitfalls regarding the histopathology and immunophenotype of small 'cytoplasmically-poor' neoplasms are a diagnostic hazard in head and neck surgical pathology practice, and require knowledge of histomorphologic plasticity and aberrant immunophenotyping., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Pseudomyogenic hemangioendothelioma (PHE) is an uncommon mesenchymal tumor of intermediate malignant potential with characteristic clinicopathologic and genetic features. Although bone involvement accompanies nearly one-fourth of reported cases of soft tissue PHEs, primary intraosseous PHE is rare. Herein, we report five cases of primary intraosseous PHEs. Male to female ratio was 4:1, with an average age of 28 years (age range, 5-44 years). Radiologically, tumors presented as lytic lesions in the proximal femur (two), diaphysis of the tibia (one), distal radius (one) and vertebrae (one). Multifocal lesions were observed in four cases. Histopathologic examination revealed plump spindle cells and prominent nucleoli. New bone formation was noted in three cases. Immunohistochemically, all tumors were positive for CD31 and negative for CD34. Pan Cytokeratin (CK) (AE1/3) was positively expressed in all, except a single tumor, in which CK7 and Cam5.2 were expressed. INI1/SMARCB1 was completely retained in all tumors. A single patient underwent surgical resection. During follow-up, two cases showed no evidence of disease within two and five years, respectively. Differential diagnosis of a PHE of bone includes osteoblastoma, epithelioid angiosarcoma, metastatic carcinoma, metastatic rhabdomyosarcoma, and epithelioid sarcoma. Caution must be exercised as pan CK (AE1/3) might not be expressed; therefore, the use of other cytokeratins, such as Cam5.2 is recommended. Awareness of such an entity in bone is the key to the diagnosis., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Endometrial stromal sarcoma (ESS) is an uncommon uterine neoplasm, but its occurrence as an extra-uterine primary (EESS) is exceedingly unusual, and the fine-needle aspiration (FNA) cytopathology of EESS is rarely described. We hereby present 2 women with primary gastric EESS whereby the FNA cytopathology of this rare entity showed a population of cytologically monotonous oval-spindle shaped cells. This cytopathology is correlated with the subsequent histopathology. EESS is another, albeit rare, diagnostic consideration along with gastrointestinal stromal tumor, schwannoma, glomus tumor, and leiomyoma of cytologically bland neoplasms of the stomach that can be encountered using endoscopic ultrasound-guided FNA biopsy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Although CD31 has been considered one of the better, if not the best, immunohistochemical marker of endothelial cells and thereby vascular neoplasia, it is not unequivocally specific to this group of tumors. We examined CD31 staining in 34 plasmacytic lesions including 15 plasma cell myelomas, 1 extraosseous plasmacytoma, 10 plasmablastic variants of myeloma, 5 plasmablastic non-Hodgkin lymphomas, and 3 reactive plasmacytic infiltrates. All reactive plasma cellular infiltrates, 93% of plasma cell myelomas, 80% of plasmablastic variants of myelomas, and 20% of plasmablastic non-Hodgkin lymphoma cases were CD31 positive with usually diffuse and strong membranous staining. When ERG staining was performed, none were ERG positive. Plasmablastic variant of myeloma is another large cell malignancy that has the potential to be mistaken for a poorly differentiated epithelioid vascular neoplasm if CD31 is presumed to be an explicit marker of endothelial cells., (© 2013.)

We report an example of an esophageal giant fibrovascular polyp harboring a well-differentiated liposarcoma with rhabdomyomatous differentiation in a 68 year-old man. Initial imaging studies including fiberoptic endoscopy and 2 computed tomographic examinations, and laparoscopic myotomy failed to demonstrate the polypoid intraluminal nature of the lesion. Thus, alternative diagnoses including a malignant neoplasm and achalasia were entertained. A third computed tomography with contrast showed a pedunculated mass. Surgical resection revealed a 15-cm smooth-surfaced club-shaped mass composed of a well-differentiated liposarcoma demonstrating myoglobin, muscle-specific actin, and myogenin-positive rhabdomyomatous differentiation. To date, no previously reported giant fibrovascular polyp case has described a liposarcoma with rhabdomyomatous change.

Benign nerve sheath tumors of the adrenal gland are an extremely uncommon cause of an incidentaloma. We report a case of a schwannoma of the adrenal medulla in an asymptomatic 51-year-old woman, which was discovered incidentally on a computed tomography scan after routine workup for her degenerative joint diseases of the lumbar spine. Because of the large size and unknown biologic nature of the tumor by clinical and radiographic studies alone, an adrenalectomy was performed. The gross specimen featured a well-circumscribed medullary based tumor with cystic degeneration. The diagnosis of a nerve sheath tumor was based on classic histological findings, supported by S-100 positivity, and ultrastructurally by the finding of typical Schwann cells. The cytological diagnosis from the fine-needle aspiration biopsy material obtained at the time of gross examination was much more challenging on retrospective review. The aspirated material showed a round- to oval-cell predominant smear with occasional striking anisonucleosis, intranuclear inclusions (so-called ancient change), and pigment deposition. A review of the histogenesis and differential diagnosis of this common nerve sheath tumor in this unusual location is discussed.

An oncocyte is a cell containing an abundant amount of deeply eosinophilic finely granular cytoplasm, rounded nuclei, and variable presence of nucleoli in conventional hematoxylin-eosin-stained sections. In the head and neck, a small number of lesions are constructed overwhelmingly of oncocytes; a larger number of nononcocytic lesions composed of cells that imitate this morphology are also encountered. Correlating the fine-needle aspiration cytology and histology of both oncocytic and oncocyte-like neoplasms can assist in avoiding interpretive pitfalls among these lesions.

The Sister Mary Joseph (SMJ) nodule is a clinical sign of metastatic cancer involving the umbilicus. The vast majority of these instances represent adenocarcinomas arising from ovarian or colorectal primaries. We present a patient who presented with ascites and the SMJ lesion that turned out to be a metastatic gastrointestinal stromal tumor after fine needle aspiration biopsy was performed. The lesion was subsequently histologically confirmed. Gastrointestinal stroma tumor involving the umbilicus is exceedingly uncommon and only rarely presents in this fashion. The cytomorphological features, differential diagnosis, and comparison with the tissue specimen are made.

We evaluated the clinicopathological spectrum of intrathoracic rhabdoid carcinoma, including its immunophenotype and ultrastructural features. Our series included 6 cases arising from the lung (4 cases) and the anterior mediastinum (2 cases). The patients were 4 men and 1 woman aged between 40 and 63 years (median, 53 years). Microscopically, all of the lesions were composed of loosely cohesive, large, atypical polygonal cells, with glassy cytoplasms and eccentric nuclei. Chromatin texture was finely granular or open. On immunohistochemical stain, the neoplastic cells were positive for vimentin in all cases, positive for vimentin, keratins and/or epithelial membrane antigen in all cases, and negative for other antigens. In 1 case, neoplastic cells were also positive for CD34. Electron microscopic study showed prominent perinuclear whorls of densely packed intermediate filaments or mitochondria. All patients were treated with combined chemotherapy and radiotherapy. One patient died 8 months after the diagnosis was made. Of the remaining patients, 3 are alive with evidence of disease progression, including brain metastases. We concluded that rhabdoid neoplasms arising in the thoracic cavity are aggressive tumors of epithelial lineage and should be categorized as true "rhabdoid carcinomas" instead of being ambiguously designated as "intrathoracic rhabdoid tumors" or "carcinomas with rhabdoid phenotype."

An appraisal of the cytopathology and corresponding histopathology of epithelial, germ cell, and lymphoid lesions of the mediastinum was previously reported in the Journal. This report aims to complete that topic with a discussion focusing on the correlative cyto-histopathology of the major mesenchymal, neural, and neuroendocrine neoplasms from this anatomic site. As previously stated, the mediastinum remains an uncommon site for fine needle aspiration (FNA) biopsy when compared with other anatomic sites. Yet, the recent use of endoscopic ultrasound-guided FNA for sampling mediastinal masses may increase this use. The purpose of this review is to focus on the shared and dissimilar morphologic features of this subset of neoplasms to improve diagnostic correlation between the two.

Sclerosing perineurioma is a recently described rare benign nerve sheath tumor. The cytopathology of this neoplasm has, to our knowledge, not previously been described. We report the fine needle aspiration cytopathology of sclerosing perineurioma, discuss potential pitfalls in cytologic interpretation, and compare the aspirate with the corresponding resection specimen.

Giant cell tumor of soft tissue is an uncommon neoplasm. To our knowledge, its cytopathology obtained using the fine-needle aspiration biopsy technique has not been previously described. We report an example of the fine-needle aspiration cytology of giant cell tumor of soft tissue in a 40-year-old woman, and correlate it with the corresponding tissue specimen.

Mucoepidermoid carcinoma of the lacrimal sac is a rare entity. We report a case of mucoepidermoid carcinoma arising in the lacrimal sac of a 30-year-old man who presented with an inner canthal mass. To our knowledge this is the first example of the cytopathology of this neoplasm in this anatomic site., (Copyright 2003, Elsevier Science (USA). All rights reserved.)

The last several years have witnessed an increase in reports regarding the pathology and classification of mediastinal neoplasms that heretofore have received relatively scant attention in comparison to tumors from other anatomic locations. Some of these, such as thymoma, remain controversial and contentious subjects. The sampling and diagnosis of mediastinal tumors using the technique of fine-needle aspiration biopsy has not gained acceptance among radiologists, surgeons, and pathologists to the degree it has for tumors of the thyroid or breast. Thus, the literature regarding aspiration cytopathology of mediastinal neoplasms is extremely limited. This report focuses on the salient cytopathologic features of epithelial, lymphoid, and germ cell tumors of the mediastinum and correlates the cytomorphology with their histologic equivalent., (Copyright 2002 by W.B. Saunders Company)