Metastatic Neoplasms in Fine-Needle Aspiration Cytology: Diagnostic Tips and Traps

198 Pages·2016·12.98 MB·English

by  Yun Gong (auth.)

Yun Gong
Metastatic Neoplasms
in Fine-Needle
Aspiration Cytology
Diagnostic Tips and Traps
123
Metastatic Neoplasms in Fine-Needle
Aspiration Cytology

Yun Gong
Metastatic Neoplasms
in Fine-Needle
Aspiration Cytology
Diagnostic Tips and Traps
Yun Gong
Professor
Department of Pathology
The University of Texas
M D Anderson Cancer Center
Houston , TX , USA
ISBN 978-3-319-23620-9 ISBN 978-3-319-23621-6 (eBook)
DOI 10.1007/978-3-319-23621-6
Library of Congress Control Number: 2015949645
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2016
T his work is subject to copyright. All rights are reserved by the Publisher, whether
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To my family, colleagues,
and fellows for their love and
support

Pref ace
To effectively help a clinician make an optimal personalized thera-
peutic decision, it is important for a cytopathologist not only to
make an accurate diagnosis on fine-needle aspiration (FNA)
samples but also to provide prognostic and therapeutically predic-
tive information. Knowledge of clinicians’ needs and clinical
impact of a FNA diagnosis is of paramount importance during the
workup of a metastatic neoplasm.
T his book provides a road map with which to navigate the
thought process in reaching a proper final FNA diagnosis. In con-
trast to most cytology books that describe the morphologic features
and ancillary study findings of each disease entities in various
organ systems in a “horizontal and detail manner,” this book is
organized in a “longitudinal and cohesive fashion” to address diag-
nostic thought process, starting from rapid on-site immediate
evaluation and sample triage strategy. The main framework of
diagnostic approach includes metastatic pattern, morphologic pat-
tern, and immunophenotypic pattern. The morphologic evaluation
is stratified into lineage-specific and lineage-nonspecific patterns
and the general cytologic features and differential diagnoses of the
major entities/subtypes (rather than each individual tumor entities)
are summarized. A systematic, tired algorithm is well outlined in
immunoperoxidase workup. The pitfalls or traps that may be
encountered in daily practice are emphasized and the solutions or
tips are provided together with high- quality cytologic images,
many of which have corresponding histologic or cell block images
and immunostaining i llustrations. A multidisciplinary approach is
the key to avoid erroneous diagnosis.
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viii Preface
This book may also serve as a reference for commonly used
immunostaining makers (Tables 4.1 and 4 .2 ) and characteristic
phenotypes of the common tumor entities within each of the four
major lineages (i.e., epithelial, melanocytic, hematopoietic, and
mesenchymal) (Tables 4 .8 , 4 .9 , 4.10, and 4 .11) and their main
subtypes. Flow cytometric immunophenotyping, cytogenetic, and
molecular studies including recently developed and promising
markers that may change pathology practice are also covered.
I n the era of molecular diagnostics and targeted personalized
therapy, a high-quality tumor sample is imperative. The book
shares practical experience of MD Anderson and covers the strategies
regarding how to use small and limited FNA samples for making
the most informative diagnosis and how to preserve tumor tissues
for cytogenetic and genomic tests that, in turn, facilitate diagnosis
and targeted therapies.
I believe that this book is a helpful complement to many excellent
cytologic books and hope that you will find the book useful in your
daily practice. Any feedback from you is very much welcomed.

Special Acknowledgment
T he author wishes to express her gratitude to the following for
their valuable help to the book:
Kim-Anh T Vu at the Department of Pathology for editing
images of the book.
Houston, TX, USA Yun Gong, MD
Contents
1 Introduction .................................................................... 1
Metastatic Pattern............................................................. 2
Morphologic Pattern ........................................................ 11
Immunophenotypic Pattern .............................................. 12
Suggested Readings ......................................................... 14
2 Sample Collection, Preparation, Rapid On-Site
Evaluation, and Triage .................................................. 17
Sample Collection and Preparation ................................. 17
Rapid On-Site Evaluation and Sample Triage ................. 18
General Strategies of Sample Triage ............................... 31
Suggested Readings ......................................................... 33
3 Morphologic Evaluation ................................................ 35
Lineage-Specific Pattern .................................................. 35
Adenocarcinoma .......................................................... 35
Squamous Carcinoma .................................................. 48
Neuroendocrine Carcinoma ......................................... 50
Urothelial Carcinoma, Renal Cell Carcinoma,
Hepatocellular Carcinoma, and Adrenal
Cortical Carcinoma ...................................................... 52
Mesothelioma ............................................................... 57
Germ Cell Tumors ....................................................... 58
Lineage-Nonspecific Pattern ............................................ 59
Tumors with Epithelioid Cell Appearance .................. 59
Tumors with Spindle Cell Appearance ....................... 63
Tumors with Small Cell Appearance ........................... 68
Tumors with Pleomorphic Cell Appearance ................ 77
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