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  • Print publication year: 2010
  • Online publication date: March 2011

Chap 36 - CYTOLOGY OF SOFT TISSUE LESIONS

Summary

Almost 9,000 soft tissue sarcomas (and 2,500 bone sarcomas) are diagnosed annually in the United States; <1% of the 1,444,920 new cancer cases diagnosed in the United States in 2007. Benign soft tissue tumors outnumber sarcomas by approximately 100:1, increasing the yearly incidence of all soft tissue tumors to about 300 per 100,000.

The use of fine-needle aspiration (FNA) as a primary diagnostic tool in soft tissue lesions is still uncommon, resulting in the lack of experience among many cytopathologists. Lack of experience coupled with the ever-present sampling error in larger masses has led to the avoidance of FNA as the primary diagnostic tool in most medical centers.

The knowledge of general soft tissue surgical pathology cannot be overemphasized. All aspirates should be evaluated with the clinical and imaging data in mind. Cytopathologists, clinicians, and radiologists must work closely together to arrive at the best and most accurate diagnosis. Ancillary techniques, especially cytogenetics, should be employed whenever appropriate.

To give perspective on fine needle aspiration practice, we list here the most common soft tissue masses aspirated at the Institute of Oncology (IO), in Ljubljana, Slovenia. The FNA clinic at IO opened in 1959 and has a volume of approximately 10,000 annual aspirates in the last 20 years. In 2004, of these, 1,818 were aspirates of soft tissues (Table 36.1). To avoid confusion, we will list only the entities that are most common and well defined.

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REFERENCES
Jemal, A, Siegel, R, Ward, E, Murray, T, Xu, J, Thun, MJ. Cancer statistics, 2007. CA Cancer J Clin 2007 Jan–Feb;57 (1):43–66.
Hajdu, S. Soft Tissue and Bone. In Bibbo, M. Comprehensive Cytopathology, ed 2. Philadelphia, WB Saunders, 1997.
Brown, FM. Soft Tissue. In: Cibas, E, Ducatman, B. Cytology: Diagnostic Principles and Clinical Correlates, ed 2. Edinburgh, WB Saunders, 2003.
Beiske, K, Ambros, PF, Burchill, SA, Cheung, IY, Swerts, K. Detecting minimal residual disease in neuroblastoma patients – the present state of the art [review]. Cancer Lett 2005 Oct 18;228(1–2):229–40.
Akerman, M, Rydholm, A. Aspiration cytology of lipomatous tumors: a 10-year experience at an orthopedic oncology center. Diagn Cytopathol 1987 Dec;3(4):295–302.
James, LP. Cytopathology of mesenchymal repair. Diagn Cytopathol 1985 Apr–Jun;1(2):91–104.
May, RM. The Art and Science of Cytopathology. Chicago, ASCP Press, 1996.
Kloboves-Prevodnik, VV, Us-Krasovec, M, Gale, N, Lamovec, J. Cytological features of lipoblastoma: a report of three cases. Diagn Cytopathol 2005 Sep;33(33):195–200.
Domanski, HA, Carlen, B, Jonsson, K, Mertens, F, Akerman, M. Distinct cytologic features of spindle cell lipoma. A cytologic-histologic study with clinical, radiologic, electron microscopic, and cytogenetic correlations. Cancer 2001 Dec 25;93(93):381–389.
Yong, M, Raza, AS, Greaves, TS, Cobb, CJ. Fine-needle aspiration of a pleomorphic lipoma of the head and neck: a case report. Diagn Cytopathol 2005 Feb;32(32):110–113.
Lemos, MM, Kindblom, LG, Meis-Kindblom, JM, Remotti, F, Ryd, W, Gunterberg, B. Fine-needle aspiration characteristics of hibernoma. Cancer 2001 Jun 25;93(93):206–210.
Walaas, L, Kindblom, LG. Lipomatous tumors: a correlative cytologic and histologic study of 27 tumors examined by fine needle aspiration cytology. Hum Pathol 1985 Jan;16(16):6–18.
Nemanqani, D, Mourad, WA. Cytomorphologic features of fine-needle aspiration of liposarcoma. Diagn Cytopathol 1999 Feb;20(20):67–69.
Szadowska, A, Lasota, J. Fine needle aspiration cytology of myxoid liposarcoma; a study of 18 tumours. Cytopathology 1993;4(4):99–106.
Kempson, RL, Fletcher, CDM, Evans, HL, Hendrickson, MR, Sibley, RK. Atlas of Tumor Pathology: Tumors of Soft Tissues. Washington, DC, Armed Forces Institute of Pathology, 2001.
Dahl, I, Akerman, M. Nodular fasciitis: a correlative cytologic and histologic study of 13 cases. Acta Cytol 1981 May–Jun;25(25):215–223.
Raab, SS, Silverman, JF, McLeod, DL, Benning, TL, Geisinger, KR. Fine needle aspiration biopsy of fibromatoses. Acta Cytol 1993 May–Jun;37(37):323–328.
Kilpatrick, SE, Geisinger, KR. Soft tissue sarcomas: the usefulness and limitations of fine-needle aspiration biopsy [review]. Am J Clin Pathol 1998 Jul;110(110):50–68.
Odashiro, AN, Odashiro Miiji, LN, Odashiro, DN, Nguyen, GK. Mammary myofibroblastoma: report of two cases with fine-needle aspiration cytology and review of the cytology literature. Diagn Cytopathol 2004 Jun;30(30):406–410.
Jurcić, V, Perković, T, Pohar-Marinsek, Z, Hvala, A, Lazar, I. Infantile myofibroma in a prematurely born twin: a case report. Pediatr Dermatol 2003 Jul–Aug;20(20):345–349.
Ostrowski, ML, Bradshaw, J, Garrison, D. Infantile myofibromatosis: diagnosis suggested by fine-needle aspiration biopsy. Diagn Cytopathol 1990;6(6):284–248.
Pohar-Marinsek, Z, Flezar, M, Lamovec, J. Acral myxoinflammatory fibroblastic sarcoma in FNAB samples: can we distinguish it from other myxoid lesions?Cytopathology 2003 Apr;14(14):73–78.
García-García, E, Rodríguez-Gil, Y, Suárez-Gauthier, A, Martínez-Tello, FJ, López-Ríos, F, Ballestín, C. Myxoinflammatory fibroblastic sarcoma: report of a case with fine needle aspiration cytology. Acta Cytol 2007 Mar–Apr;51(51):231–234.
Akerman, M, Domanski, H. The cytological features of soft tissue tumors in fine needle aspiration smears classified according to histotype. In: The Cytology of Soft Tissue Tumors. Basel, Switzerland, Karger 2003, p. 40–41
Merck, C, Hagmar, B. Myxofibrosarcoma: a correlative cytologic and histologic study of 13 cases examined by fine needle aspiration cytology. Acta Cytol 1980 Mar–Apr;24(24):137–144.
Kilpatrick, SE, Ward, WG. Myxofibrosarcoma of soft tissues: cytomorphologic analysis of a series. Diagn Cytopathol 1999 Jan;20(20):6–9.
Dawiskiba, S, Eriksson, L, Elner, A, Johansen, CC, Hansson, LG, Westesson, PL. Diffuse pigmented villonodular synovitis of the temporomandibular joint diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 1989;5(5):301–304.
Wakely, PE Jr, Frable, WJ. Fine-needle aspiration biopsy cytology of giant-cell tumor of tendon sheath. Am J Clin Pathol 1994 Jul;102(102):87–90.
Gupta, K, Dey, P, Goldsmith, R, Vasishta, RK. Comparison of cytologic features of giant-cell tumor and giant-cell tumor of tendon sheath. Diagn Cytopathol 2004 Jan;30(30):14–18.
Nguyen, GK, Neifer, R. The cells of benign and malignant hemangiopericytomas in aspiration biopsy. Diagn Cytopathol 1985 Oct–Dec;1(1):327–331.
Walaas, L, Angervall, L, Hagmar, B, Save-Soderbergh, J. A correlative cytologic and histologic study of malignant fibrous histiocytoma: an analysis of 40 cases examined by fine-needle aspiration cytology. Diagn Cytopathol 1986 Jan–Mar;2(2):46–54.
Berardo, MD, Powers, CN, Wakely, PE Jr, Almeida, MO, Frable, WJ. Fine-needle aspiration cytopathology of malignant fibrous histiocytoma. Cancer 1997 Aug 25;81(81):228–237.
Klijanienko, J, Caillaud, JM, Lagace, R, Vielh, P. Comparative fine-needle aspiration and pathologic study of malignant fibrous histiocytoma: cytodiagnostic features of 95 tumors in 71 patients. Diagn Cytopathol 2003 Dec;29(29):320–326.
Mooney, EE, Layfield, LJ, Dodd, LG. Fine-needle aspiration of neural lesions. Diagn Cytopathol 1999 Jan;20(20):1–5.
Yu, GH, Sack, MJ, Baloch, Z, Gupta, PK. Difficulties in the fine needle aspiration (FNA) diagnosis of schwannoma. Cytopathology 1999 Jun;10(10):186–194.
Resnick, JM, Fanning, CV, Caraway, NP, Varma, DG, Johnson, M. Percutaneous needle biopsy diagnosis of benign neurogenic neoplasms. Diagn Cytopathol 1997 Jan;16(16):17–25.
Dodd, LG, Marom, EM, Dash, RC, Matthews, MR, McLendon, RE. Fine-needle aspiration cytology of “ancient” schwannoma. Diagn Cytopathol 1999 May;20(20):307–311.
Rorat, E, Yang, W, DeLaTorre, R. Fine needle aspiration cytology of parapharyngeal meningioma [review]. Acta Cytol 1991 Sep–Oct;35(35):497–500.
Baisden, BL, Hamper, UM, Ali, SZ. Metastatic meningioma in fine-needle aspiration (FNA) of the lung: cytomorphologic finding. Diagn Cytopathol 1999 May;20(20):291–4.
Pohar-Marinsek, Z, Frković-Grazio, S. Fine needle aspiration (FNA) cytology of primary subcutaneous sacrococcygeal myxopapillary ependymoma. Cytopathology 1998 Dec;9(9):415–420.
Kulesza, P, Tihan, T, Ali, SZ. Myxopapillary ependymoma: cytomorphologic characteristics and differential diagnosis. Diagn Cytopathol 2002 Apr;26(26):247–250.
McGee, RS Jr, Ward, WG, Kilpatrick, SE. Malignant peripheral nerve sheath tumor: a fine-needle aspiration biopsy study. Diagn Cytopathol 1997 Oct;17(17):298–305.
Klijanienko, J, Caillaud, JM, Lagace, R, Vielh, P. Cytohistologic correlations of 24 malignant peripheral nerve sheath tumor (MPNST) in 17 patients: the Institut Curie experience. Diagn Cytopathol 2002 Aug;27(27):103–108.
Bondeson, L, Andreasson, L. Aspiration cytology of adult rhabdomyoma. Acta Cytol 1986 Nov–Dec;30(30):679–682.
Domanski, HA, Dawiskiba, S. Adult rhabdomyoma in fine needle aspirates. A report of two cases. Acta Cytol. 2000 Mar–Apr;44(44):223–226.
Newton, WA Jr, Gehan, EA, Webber, BL, Marsden, HB, Unnik, AJ, Hamoudi, AB. Classification of rhabdomyosarcomas and related sarcomas. Pathologic aspects and proposal for a new classification–an Intergroup Rhabdomyosarcoma Study. Cancer 1995 Sep 15;76(76):1073–1085.
Qualman, SJ, Coffin, CM, Newton, WA, Hojo, H, Triche, TJ, Parham, DM. Intergroup Rhabdomyosarcoma Study: update for pathologists [review]. Pediatr Dev Pathol 1998 Nov–Dec;1(1):550–61.
Pohar-Marinsek, Z, Bracko, M. Rhabdomyosarcoma: Cytomorphology, subtyping and differential diagnostic dilemmas. Acta Cytol 2000 Jul–Aug;44(44):524–532.
Pohar-Marinsek, Z, Us-Krasovec, M, Golouh, R, Zganec, M. Value of image cytometry in the subclassification of rhabdomyosarcoma. Anal Quant Cytol Histol. 2002 Aug;24(24): 212–220.
Pohar-Marinsek, Z, Anzic, J, Jereb, B. Topical topic: value of fine needle aspiration biopsy in childhood rhabdomyosarcoma: twenty-six years of experience in Slovenia. Med Pediatr Oncol 2002 Jun;38(38):416–420.
Pohar-Marinsek, Z, Bracko, M, Lavrencak, J, Us-Krasovec, M. DNA ploidy as a prognostic factor in rhabdomyosarcoma. Analysis of 35 cases with image cytometry. Anal Quant Cytol Histol 2003 Aug;25(25):235–242.
Dahl, I, Hagmar, B, Angervall, L. Leiomyosarcoma of the soft tissue. A correlative cytological and histological study of 11 cases. Acta Pathol Microbiol Scand [A] 1981 Jul;89(89):285–291.
Tao, LC, Davidson, DD. Aspiration biopsy cytology of smooth muscle tumors. A cytologic approach to the differentiation between leiomyosarcoma and leiomyoma. Acta Cytol 1993 May–Jun;37(37):300–308.
Klijanienko, J, Caillaud, JM, Lagace, R, Vielh, P. Fine-needle aspiration of leiomyosarcoma: a correlative cytohistopathological study of 96 tumors in 68 patients. Diagn Cytopathol 2003 Mar;28(28):119–125.
Domanski, HA, Akerman, M, Rissler, P, Gustafson, P. Fine-needle aspiration of soft tissue leiomyosarcoma: an analysis of the most common cytologic findings and the value of ancillary techniques. Diagn Cytopathol 2006 Sep;34(34):597–604.
Weiss, SW, Goldblum, JR. Malignant vascular tumors. In : Strauss M, editor. Enzinger's and Weiss's soft tissue tumors. 4th ed. St. Louis, Mosby, 2001, pp. 917–954.
Liu, K, Layfield, LJ. Cytomorphologic features of angiosarcoma on fine needle aspiration biopsy. Acta Cytol 1999 May–Jun;43(43):407–415.
Boucher, LD, Swanson, PE, Stanley, MW, Silverman, JF, Raab, SS, Geisinger, KR. Cytology of angiosarcoma. Findings in fourteen fine-needle aspiration biopsy specimens and one pleural fluid specimen. Am J Clin Pathol 2000 Aug;114(114):210–219.
Minimo, C, Zakowski, M, Lin, O. Cytologic findings of malignant vascular neoplasms: a study of twenty-four cases. Diagn Cytopathol 2002 Jun;26(26):349–55.
Klijanienko, J, Caillaud, JM, Lagace, R, Vielh, P. Cytohistologic correlations in angiosarcoma including classic and epithelioid variants: Institut Curie's experience. Diagn Cytopathol 2003 Sep;29(29):140–145.
Gagner, JP, Yim, JH, Yang, GC. Fine-needle aspiration cytology of epithelioid angiosarcoma: a diagnostic dilemma. Diagn Cytopathol. 2005 Dec;33(33):429–433. Review.
Carson, KF, Hirschowitz, SL, Nieberg, RK, Sadeghi, S. Pitfalls in the cytologic diagnosis of angiosarcoma of the breast by fine-needle aspiration: a case report. Diagn Cytopathol 1994;11(11):297–9; discussion, 299–300.
Jeon, YK, Kim, HW, Choi, HJ, Park, IA. Fine needle aspiration cytology of epithelioid angiosarcoma. Report of a case with nuclear grooves and indentations. Acta Cytol 2004 Mar–Apr;48(48):223–228.
Vesoulis, Z, Cunliffe, C. Fine-needle aspiration biopsy of postradiation epithelioid angiosarcoma of breast. Diagn Cytopathol 2000 Mar;22(22):172–175.
Kilpatrick, SE, Koplyay, PD, Ward, WG, Richards, F. Epithelioid hemangioendothelioma of bone and soft tissue: a fine-needle aspiration biopsy study with histologic and immunohistochemical confirmation. Diagn Cytopathol 1998 Jul 1;19(19):38–43.
Pettinato, G, Insabato, L, Chiara, A, Forestieri, P, Manco, A. Epithelioid hemangioendothelioma of soft tissue. Fine needle aspiration cytology, histology, electron microscopy and immunohistochemistry of a case. Acta Cytol 1986 Mar–Apr;30(30):194–200.
Handa, U, Palta, A, Mohan, H, Punia, RP. Aspiration cytology of glomus tumor: a case report. Acta Cytol 2001 Nov–Dec;45(45):1073–1076.
Wong, NL. Fine needle aspiration cytology of pseudosarcomatous reactive proliferative lesions of soft tissue. Acta Cytol 2002 Nov–Dec;46(46):1049–1055.
Akerman, M. Benign fibrous lesions masquerading as sarcomas. Clinical and morphological pitfalls. Acta Orthop Scand Suppl 1997 Feb;273:37–40.
Doria, MI Jr, Wang, HH, Chinoy, MJ. Retroperitoneal mesenchymal chondrosarcoma. Report of a case diagnosed by fine needle aspiration cytology. Acta Cytol 1990 Jul–Aug;34(34):529–532.
Trembath, DG, Dash, R, Major, NM, Dodd, LG. Cytopathology of mesenchymal chondrosarcomas: a report and comparison of four patients. Cancer 2003 Aug 25;99(99):211–216.
Wakely, PE, Bos, GD, Mayerson, J. The cytopathology of soft tissue mxyomas: ganglia, juxta-articular myxoid lesions, and intramuscular myxoma. Am J Clin Pathol 2005 Jun;123(123):858–865.
Caraway, NP, Staerkel, GA, Fanning, CV, Varma, DG, Pollock, RE. Diagnosing intramuscular myxoma by fine-needle aspiration: a multidisciplinary approach. Diagn Cytopathol 1994;11(11):255–261.
Akerman, M, Rydholm, A. Aspiration cytology of intramuscular myxoma. A comparative clinical, cytologic and histologic study of ten cases. Acta Cytol 1983 Sep–Oct;27(27):505–510.
Crapanzano, JP. Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases. Diagn Cytopathol 2005 Jan;32(32):53–7.
Handa, U, Nanda, A, Mohan, H. Fine-needle aspiration of renal angiomyolipoma: a report of four cases. Cytopathology. 2007 Aug;18(18):250–254.
Wieczorek, TJ, Krane, JF, Domanski, HA, Akerman, M, Carlen, B, Misdraji, J. Cytologic findings in granular cell tumors, with emphasis on the diagnosis of malignant granular cell tumor by fine-needle aspiration biopsy. Cancer 2001 Dec 25;93(93):398–408.
Kilpatrick, SE, Teot, , Stanley, MW, Ward, WG, Savage, PD, Geisinger, KR. Fine-needle aspiration biopsy of synovial sarcoma. A cytomorphologic analysis of primary, recurrent, and metastatic tumors. Am J Clin Pathol 1996 Dec;106(106):769–775.
Akerman, M, Ryd, W, Skytting, B. Scandinavian Sarcoma Group: Fine-needle aspiration of synovial sarcoma: criteria for diagnosis: retrospective reexamination of 37 cases, including ancillary diagnostics. A Scandinavian Sarcoma Group study. Diagn Cytopathol 2003 May;28(28):232–238.
Klijanienko, J, Caillaud, JM, Lagace, R, Vielh, P. Cytohistologic correlations in 56 synovial sarcomas in 36 patients: the Institut Curie experience. Diagn Cytopathol. 2002 Aug;27(27):96–102.
Viguer, JM, Jimenez-Heffernan, JA, Vicandi, B, Lopez-Ferrer, P, Gamallo, C. Cytologic features of synovial sarcoma with emphasis on the monophasic fibrous variant: a morphologic and immunocytochemical analysis of bcl-2 protein expression. Cancer 1998 Feb 25;84(84):50–56.
Akerman, M, Willen, H, Carlen, B, Mandahl, N, Mertens, F. Fine needle aspiration (FNA) of synovial sarcoma–a comparative histological-cytological study of 15 cases, including immunohistochemical, electron microscopic and cytogenetic examination and DNA-ploidy analysis. Cytopathology 1996 Jun;7(7):187–200.
Ewing, CA, Zakowski, MF, Lin, O. Monophasic synovial sarcoma: a cytologic spectrum. Diagn Cytopathol 2004 Jan;30(30):19–23.
Silverman, JF, Landreneau, RJ, Sturgis, CD, Raab, SS, Fox, KR, Jasnosz, KM. Small-cell variant of synovial sarcoma: fine-needle aspiration with ancillary features and potential diagnostic pitfalls. Diagn Cytopathol 2000 Aug;23(23):118–123.
Inagaki, H, Murase, T, Otsuka, T, Eimoto, T. Detection of SYT-SSX fusion transcript in synovial sarcoma using archival cytologic specimens. Am J Clin Pathol 1999 Apr;111(111):528–533.
Pohar-Marinsek, Z, Zidar, A. Epithelioid sarcoma in FNAB smears. Diagn Cytopathol 1994 Dec;11(11):367–372.
Cardillo, M, Zakowski, MF, Lin, O. Fine-needle aspiration of epithelioid sarcoma: cytology findings in nine cases [review]. Cancer 2001 Aug 25;93(93):246–251.
Bakhos, R, Andrey, J, Bhoopalam, N, Jensen, J, Reyes, CV. Fine-needle aspiration cytology of extraskeletal Ewing's sarcoma. Diagn Cytopathol 1998 Feb;18(18):137–140.
Renshaw, AA, Perez-Atayde, AR, Fletcher, JA, Granter, SR. Cytology of typical and atypical Ewing's sarcoma/PNET. Am J Clin Pathol 1996 Nov;106(106):620–624.
Das, DK. Fine-needle aspiration (FNA) cytology diagnosis of small round cell tumors: value and limitations [review]. Indian J Pathol Microbiol 2004 Jul;47(47):309–318.
Lopez-Ferrer, P, Jimenez-Heffernan, JA, Vicandi, B, Gonzalez-Peramato, P, Viguer, JM. Cytologic features of alveolar soft part sarcoma: report of three cases. Diagn Cytopathol 2002 Aug;27(27):115–119.
Shabb, N, Sneige, N, Fanning, CV, Dekmezian, R. Fine-needle aspiration cytology of alveolar soft-part sarcoma. Diagn Cytopathol 1991;7(7):293–298.
Creager, AJ, Pitman, MB, Geisinger, KR. Cytologic features of clear cell sarcoma (malignant melanoma) of soft parts: a study of fine-needle aspirates and exfoliative specimens. Am J Clin Pathol 2002 Feb;117(117):217–224.
Tong, TR, Chow, TC, Chan, OW, Lee, KC, Yeung, SH, Lam, A. Clear-cell sarcoma diagnosis by fine-needle aspiration: cytologic, histologic, and ultrastructural features; potential pitfalls and literature review [review]. Diagn Cytopathol 2002 Mar;26(26):174–180.
Almeida, MM, Nunes, AM, Frable, WJ. Malignant melanoma of soft tissue. A report of three cases with diagnosis by fine needle aspiration cytology. Acta Cytol 1994 Mar–Apr;38(38):241–246.
Jakowski, JD, Wakely, PE. Cytopathology of extraskeletal myxoid chondrosarcoma: report of 8 cases. Cancer 2007 Aug 3;111(111):298–305.
Caraway, NP, Fanning, CV, Amato, RJ, Ordonez, NG, Katz, RL. Fine-needle aspiration of intra-abdominal desmoplastic small cell tumor. Diagn Cytopathol 1993 Aug;9(9):465–470.
Granja, NM, Begnami, MD, Bortolan, J, Filho, AL, Schmitt, FC. Desmoplastic small round cell tumour: Cytological and immunocytochemical features. Cytojournal 2005 Mar 18;2(2):6.
Hill, DA, Pfeifer, JD, Marley, EF, Dehner, LP, Humphrey, PA, Zhu, X. WT1 staining reliably differentiates desmoplastic small round cell tumor from Ewing sarcoma/primitive neuroectodermal tumor. An immunohistochemical and molecular diagnostic study. Am J Clin Pathol 2000 Sep;114(114):345–353.
Pogacnik, A, Zidar, N. Malignant rhabdoid tumor of the liver diagnosed by fine needle aspiration cytology. A case report. Acta Cytol 1997 Mar–Apr;41(41):539–543.