Cytological evaluation of head and neck tumors in children—A pattern analysis

Abstract

A total of 135 pediatric head and neck tumors diagnosed in our institute were reviewed with a view to elucidate the overall cytological patterns and analyze the important cytological features. Ninety-four tumors (69.6%) were aspirated for a primary diagnosis, and in 41 (30.4%) cases, fine-needle aspiration cytology was performed to document relapse, recurrence or a metastasis. Among the 94 tumors aspirated for a primary diagnosis, 66 cases (70.2%) were accurately diagnosed, in 22 cases (23.4%) a broad working diagnosis was offered, and 6 cases (6.4%) were misdiagnosed. The accuracy rate was higher (79.3%) when relapse-recurrent and metastatic tumors were included. The smears were broadly divided into six patterns, viz. round cell, epithelial, anaplastic, giant cell, mixed inflammatory, and spindle cell patterns. The round cell pattern was the most frequent one encountered in this group. The cytological features that stood the test of variability were lymphoglandular bodies and a noncohesive cell population in hematolymphoid malignancies, pale chromatin and cytoplasmic vacuoles in primitive neuroectodermal tumor/Ewing's sarcoma (PNET/ES), neuropil and rosettes in neuroblastoma, and plasmacytoid rhabdomyoblasts in rhabdomyosarcoma. A fairly good accuracy was seen in the diagnosis of metastatic undifferentiated carcinoma and anaplastic lymphoma, but the giant-cell and spindle-cell tumors continued to pose a problem in diagnosis. Ancillary techniques such as immunocytochemistry and electron microscopy applied in limited cases helped evaluate Langerhans cell histiocytosis, alveolar rhabdomyosarcoma, and the PNET/ES family of tumors.

Evaluation of fine needle aspiration biopsy as a diagnostic tool in pediatric head and neck lesions

“…The utility of FNA biopsy in children has been illustrated in many studies. [5][6][7][8][9][10] As reported by Howell, the use of FNA for superficial palpable lesions is gaining momentum in the pediatric patient population. 6 To date, research detailing application of FNA to lesions of the head and neck in pediatric populations and the number of cases evaluated are limited.…”

“…Moreover, some studies have limited their focus to features of malignant lesions, such as small round cell neoplasms or salivary gland lesions. [8][9][10] The range of lesions which can be reliably diagnosed by this method is rapidly expanding. Lack of need for sedation or general anesthesia is an additional benefit in the pediatric patient.…”

“…In addition to rapid diagnosis, tissue samples retrieved from FNA biopsy can be processed further for other techniques, such as flow cytometry, cytogenetics, and electron microscopy. 7,8 The results of 662 aspirates from head and neck masses revealed an infective etiology in 125 cases (tubercular, abscess, suppurative), benign lesions in nine cases, and malignant lesions in 11 cases.…”

Metastatic retinoblastoma presenting as a left shoulder soft tissue mass: FNA findings and review of the literature

“…In such cases, retinoblastoma may be confused with other more commonly encountered members of the SRCT groups such as lymphoma, rhabdomyosarcoma, nephroblastoma (Wilms' tumor), Ewing's sarcoma/PNET, and desmoplastic small round cell tumor. [20][21][22] In addition, consideration must be given to the development of a second primary tumor. [23][24][25] Herein, we report a case of metastatic retinoblastoma presenting as a left shoulder soft tissue mass in a 14-yearold female with a 14-year history of familial bilateral retinoblastoma.…”

ALK+ Anaplastic Large Cell Lymphoma with Cohesive, Perivascular Arrangements on Cytology, Mimicking a Soft Tissue Sarcoma

“…1,2 At times, such cases present at advanced stages, and a correct diagnosis is extremely useful in initiating an appropriate therapeutic regimen. Among the various tumors, lymphomas are an unusual occurrence in soft tissues.…”