Pediatric neuroblastic tumors: A critical evaluation of cytomorphological features for risk stratification on aspiration cytology

Abstract

Background Neuroblastic tumor (NT) is the most common extracranial solid tumor of childhood with variable outcome which again depends on risk stratification related to distinct biology of the tumor. The use of fine‐needle aspiration (FNA) material for evaluation of cytomorphological parameters and risk stratification in NTs using cytology prognostic score (PS) is limited in routine practice. Methods We reviewed 38 FNA cytology cases diagnosed as pediatric small round cell tumor between time period June 2017 to December 2019 for clinical, cytomorphological and immunohistochemical features. Results Ten out of 38 small round cell tumors were NTs. All 10 cases were further subclassified according to International Neuroblastoma Pathology Classification into undifferentiated neuroblastoma (n = 1), poorly differentiated neuroblastoma (n = 5), differentiating neuroblastoma (n = 2), and ganglioneuroblastoma (n = 2). Cytologic PS was done using the morphological criteria as described previously in literature. The patients were divided into favorable and unfavorable cytomorphological prognostic categories with a cut off scoring of 12. A score of more than 12 is associated with high risk morphology and advanced stage. All cases with PS > 12 (n‐4) (unfavorable cytomorphology) had a poor outcome compared to six patients with PS < 12 (n‐6) (favorable cytomorphology). Conclusion Aspiration cytology can be used as a first line investigation to evaluate the cytomorphological features for risk stratification and diagnosis in patients with NTs using cytological prognostic scoring system. A larger multi‐centric validation study necessitates for cytological risk stratification.

Development and Carcinogenesis: Roles of GATA Factors in the Sympathoadrenal and Urogenital Systems

“…Furthermore, it is conceivable that GATA2 and GATA3 play a fundamental role in the genesis of neuroblastoma, given their roles in normal sympathoadrenal development. Consistent with this hypothesis, GATA3 was reported to be a first-line immunohistochemical marker to facilitate the pathological diagnosis of neuroblastic tumors [29]. Gata3 cis-regulatory studies using transgenic reporter mouse assays have revealed that even a 662-kb mouse Gata3 YAC containing 451-kb and 211-kb of 5′ and 3′ flanking Gata3 cis-regulatory studies using transgenic reporter mouse assays have revealed that even a 662-kb mouse Gata3 YAC containing 451-kb and 211-kb of 5 and 3 flanking sequences, respectively, was missing the regulatory element(s) that confer expression in sympathoadrenal system organs [30].…”

“…Furthermore, it is conceivable that GATA2 and GATA3 play a fundamental role in the genesis of neuroblastoma, given their roles in normal sympathoadrenal development. Consistent with this hypothesis, GATA3 was reported to be a first-line immunohistochemical marker to facilitate the pathological diagnosis of neuroblastic tumors [29].…”

Clinical Comparison of Surgical Treatment and Complications in Pediatric Patients with Neuroblastoma at Stage 4

“…Campagna et al (14) concluded that FNAB multi-stitch sampling is su cient for complete diagnosis and can replace OIB. To minimize misdiagnosis, the combination of pathology immunohistochemistry and molecular biology diagnosis is recommended to identify pNT and the rest of SRCT (15)(16)(17). Unfortunately, none of the nine cases in group B underwent further molecular biology diagnosis due to limitations of current technology.…”

Approach to Fine Needle Aspiration of Adrenal Gland Lesions

“…Morphologically, they seem similar to other "small round blue cell" neoplasms. 1,27 FNA smears are hypercellular, and composed of nested cells with high nuclear-to-cytoplasmic ratios, scant cytoplasm, and finely granular chromatin. Homer Wright rosettes, with acinar arrangements of tumor cells around fibrillary neuropil material, are occasionally identified.…”