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The kidney, adrenal gland, and retroperitoneum are important sites of disease in the pediatric population. Some of the most frequently encountered childhood neoplasms, including Wilms tumor and neuroblastoma, arise in the kidney and adrenal gland, respectively. Many of these tumors are deep-seated but amenable to fine-needle aspiration (FNA). Children with a renal, adrenal, or retroperitoneal malignancy may present at an advanced stage and be too ill to withstand the rigors of surgery. Thus, neoadjuvant chemotherapy may be used to debulk some of these tumors before surgery is performed, and an accurate cytologic diagnosis is imperative to ensure the appropriate management is undertaken. This chapter covers both common and more unusual lesions that may be encountered when looking at an FNA from this area. In addition, urine cytology in children is discussed briefly.

OBJECTIVE To review the cytologic features of hidradenoma to describe criteria that may aid in identification of these tumors at the time of aspiration and allow for a more specific diagnosis than the umbrella term of benign skin adnexal tumor. STUDY DESIGN Three patients aged 10-23 years presented with mass lesions in the region of the head. Fine needle aspiration (FNA) of these lesions showed the presence of benign skin adnexal tumors. Subsequent histology showed the presence of hidradenomas. A retrospective analysis of the cytology was performed. RESULTS The following cytomorphologic findings are consistent with the diagnosis of hidradenoma: a cystic component to the aspirate as represented by amorphous background material with or without foam cells and epithelial duct-like cells and tubular structures. In addition, a biphasic cytoplasmic staining pattern with both eosinophilic and clear to basophilic cells may be seen with the Papanicolaou stain in hidradenomas. CONCLUSION Knowledge of the cytologic features of hidradenoma will allow for correct management of the patient and prevent misdiagnosis as a malignant tumor.

Fine needle aspiration (FNA) cytology is a well-established diagnostic tool. However, most clinicians prefer to diagnose suspected skin tumors by excisional biopsy as they are easily accessible, with the result that benign skin adnexal tumors are rarely encountered on FNA, often leading to misdiagnosis and mismanagement of patients. We describe the cytologic features of chondroid syringoma in 3 cases in order to facilitate cytologic diagnosis of this lesion.Three patients each presented with a mass lesion in the head and neck region and on FNA were diagnosed as having chondroid syringomas. All diagnoses were confirmed on histology. Case 1 was a 32-year-old female who presented with a 2-cm mass involving the scalp. Case 2 was an 18-year-old female who presented with a 0.5-cm mass involving the skin of the upper lip. Case 3 was a 23-year-old male with a 2-cm mass involving the posterior scalp. All the masses involved the skin/subcutaneous tissue on clinical examination. On cytology, all 3 cases showed background fibrillary chondromyxoid material, with a prominent cellular component composed of bland epithelial and myoepitheial cells. The presence of random nuclear atypia was seen in 1 case, interpreted as degenerative as seen in ancient change.Knowledge of the cytologic features of chondroid syringoma will allow definitive diagnosis and correct management of the patient.

To review the cytologic features of pilomatrixoma to allow a definitive diagnosis at the time of aspiration and correct patient management.Three patients each presented with a mass lesion and on fine needle aspiration were diagnosed as either having pilomatrixoma or a benign skin adnexal tumor. The diagnosis was confirmed on histology. A retrospective analysis of the cytology was performed.The most consistent and predominant features for diagnosis were basaloid cells, anucleate squamous cells and calcification in an inflammatory background, often with giant cells. Only focal evidence of true shadow or "ghost" cells was seen in one case on the Diff-Quik smear. Therefore, lack of shadow cells does not preclude correct diagnosis in the presence of the other relevant cytologic features. If all the major components of pilomatrixoma are present in an aspirate, the diagnosis should not be problematic. However, if one component predominates, this may lead to an erroneous diagnosis of other benign and malignant lesions.Knowledge of the cytologic features of pilomatrixoma will allow correct patient diagnosis and management.