The results of fine needle aspiration biopsy of lymph nodes in 350 patients and the modified biopsy technique used at our institution are discussed. Of the 350 cases, 209 aspirates were categorized as cytologically malignant, 102 as benign, 30 as suspicious for malignancy, and 9 as unsatisfactory. Cervical lymph nodes were most commonly sampled (58%), and supra-clavicular nodes were most likely to be malignant (90%). The overall diagnostic accuracy achieved was 94%. One false-positive and 9 (2%) false-negative results were observed in the 350 cases. In 3% of the 30 cases diagnosed as suspicious for malignancy, follow-up open biopsy of the lymph nodes in question proved them benign. The advantages and limitations of the procedure are discussed, as well as some of the possible sources of error, particularly in the diagnosis of lymphomas.

Analysis of 1,000 cases of fine-needle aspiration biopsies of subcutaneous lesions revealed 430 cases diagnosed as malignant. Squamous cell carcinoma represented 37% of the malignant neoplasms, and many of these cases were highly differentiated tumors. Although the presence of keratinized squamous cells in superficial aspirates is strongly suggestive of squamous cell carcinoma, other lesions may produce atypical squamous cells on aspiration biopsy and should be considered in the differential diagnosis. These include acanthotic ameloblastomas, metaplastic adenocarcinomas and Warthin's tumors, branchial cleft cysts, odontogenic keratocysts, and epidermal inclusion cysts. Two-needle aspirates from these cases were incorrectly interpreted as squamous cell carcinoma. The cytologic and some of the histologic characteristics of these lesions that may pose a diagnostic problem are presented. Careful evaluation of nuclear and cytoplasmic features, cellular background, clinical findings, and history is essential to avoid a false positive diagnosis of squamous cell carcinoma.

A case of recurrent esthesioneuroblastoma was diagnosed by fine-needle aspiration of a midcervical mass. The cytologic features that characterize this uncommon neoplasm include uniform, small, round-to-oval cells with coarsely granular chromatin, multiple small nucleoli, prominent nuclear membranes, and scant cytoplasm. Morphologically and ultrastructurally, esthesioneuroblastoma cells resemble those of sympathetic neuroblastomas. Both tumors show rosette formation and minimal cellular pleomorphism, and, by electron microscopy, dense-core cytoplasmic granules can be identified. The cytologic recognition of esthesioneuroblastoma is important since it metastasizes to cervical lymph nodes accessible to fine-needle aspiration biopsy. In addition, the histogenesis of this unusual neuroectodermal tumor and its behavior are discussed.

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