Imprint cytology of adrenal cortical carcinoma. A valuable surrogate for frozen sections

Abstract

K E Y W O R D S : adrenal, adrenocortical carcinoma, cytology, fine needle aspiration, metaplastic ossification 1 | INTRODUCTION Adrenal cortical carcinoma (ACC) is a rare tumour, and its cytological findings have been described only sporadically. We here report a case of ACC in which imprint cytology played an important role in the diagnosis. Cytological findings of ACC are shown and the correlation to the histology is discussed. | OBSERVATIONA 74-years-old woman presented with right hypochondralgia and subfever. Ultrasonography (US) and blood tests suggested cholecystitis/cholangitis, which was successfully treated with antibiotics. A 66 × 38 mm-sized asymptomatic tumour was incidentally discovered around the upper pole of the left kidney. Calcification foci were scattered within the tumour (not shown). The adrenal endocrinological functions, both cortical and medullary, remained within normal range. Access to the lesion with fine needle aspiration (FNA) was difficult due to its deep location. Systemic imaging surveys showed no other tumours, so the lesion was clinically diagnosed as a potentially malignant tumour of adrenal origin. The pathologic diagnosis was to be made during the operation with frozen sections. Incision biopsy did not cut well. The sections broke into pieces. Imprint cytology was made instead and stained for rapid cytodiagnosis. The imprint slides were hypercellular. Numerous atypical cells with marked nuclear/cytoplasmic pleomorphism were seen in a haemorrhagic/necrotic background. The tumour cells had clearly defined cell border, and they showed little mutual adhesion. Anisonucleosis, irregularity of the nuclear membrane, conspicuous large eosinophilic nucleoli, and coarsely clumped chromatin were present. Multinuclear cells were often seen. Mitotic figures were occasionally observed (Figure 1A-D). These cytological findings suggested a high-grade neoplasm. According to this positive cytodiagnosis, left adrenalectomy with radical nephrectomy was performed. Permanent histologic sections of the tumour prepared after decalcification showed proliferation of atypical cells with clear cytoplasm. Approximately one thirds of the tumour was occupied with a diffuse proliferation of tumour cells (Figure 2). Remaining two thirds showed trabecular pattern covered by thin fibrous connective tissue, which was interpreted as vestigial adrenal cortex histology (not shown). In the histologic specimens, N/C ratio was lower and cellular/nuclear atypia was less obvious when compared with cytology. Besides necrosis and associated microcalcification, metaplastic ossification was widely observed ( Figure 2B). However, neither bone marrow formation nor haematopoietic myeloid cells were seen. This mature bone trabecular formation was thought to be responsible for the failure of frozen sections cutting. Mitotic figures were seen two to five per 10 high power fields (not shown). Capsular invasion ( Figure 2C) and venous invasion ( Figure 2D) were recognised. Immunohistochemically, synaptophysin and chromogranin A wer...

Imprint cytology for a subcutaneous tumour

“…In addition, a. and b. are useful as widely exploited as rapid on‐site evaluation, which can be performed outside the pathology laboratory. Rapid cytodiagnoses can be used for the material not suitable for frozen sections or when conventional frozen sections fail …”