PART TWO
Diagnostic Cytology
Fig. 17.8 Squamous carcinoma of the skin extending into the orbit. Fine-
needle aspiration shows a malignant cell with marked nuclear enlargement;
hyperchromasia (May-Grunwald-Giemsa x HP).
Langerhans histiocytosis
The combination of eosinophils and Langerhans histiocytes are
easily recognizable and characteristic (Fig. 17.9). In a young
patient presenting with sphenoid wing lesions, one may wish
to reserve some material for immunohistochemistry or electron
microscopy.12
Key features of Langerhans histiocytosis
• Histiocytes with grooved or indented nuclei
(Langerhans cells); and
• Multinucleated giant cells, eosinophils, and
neutrophils are present.
Plasma cell dyscrasias
These lesions may infrequently present with proptosis due to
orbital masses. FNA can be effective in their diagnosis, although
one would prefer to avoid this approach because the lesions may
bleed profusely.2 Cytologically atypical plasma cells are apparent.
Key features of plasma cell dyscrasias
• Atypical plasma cells often with accompanying inflam-
matory response; and
• Nuclear polymorphism and anaplasia may be present.
Schwannom a
Schwannomas occur in the orbit and usually reveal scant mate-
rial composed of spindle cells in a myxoid stroma. The nuclei
may be curved in shape.2
Key features of schwannoma
• Myxoid areas with spindle cells containing bent
nuclei; and
• Tightly packed spindle cells with characteristic Antoni
A and B may be present.
Rhabdom yosarcom a
Rhabdomyosarcoma are classified slightly differently in the
orbit than in other areas of the body; there is a differentiated
form of orbital rhabdomyosarcoma instead of the pleomorphic
Fig. 17.9 Langerhans histiocytosis. Fine-needle aspiration smears show
a background of eosinophils and histiocytes with abundant cytoplasm
and occasional longitudinal clefts in atypical nuclei. There are occasional
multinucleated cells in the smears (May-Grünwald-Giemsa x MP).
type. The tumor may be difficult to classify by cytology alone
and fluorescent in situ hybridization (FISH) can be helpful to
identify the alveolar subtype.2,67
Key features of rhabdomyosarcoma
• Small spindle shaped cells; and
• Eosinophilic cytoplasm with strap cells (differentiated
type).
Prim ary Lacrimal Gland Neoplasms
The most common lacrimal neoplasms encountered are pleo-
morphic adenoma, adenoid cystic carcinoma, and primary
adenocarcinoma. If the cellularity is adequate, one can distin-
guish pleomorphic adenoma by the chondroid matrix usually
present. Adenoid cystic carcinoma shows tumor cell rosettes
around basement membrane material. Adenocarcinoma will
show glands lined by atypical cells containing mucin. From
the surgeon's standpoint, the identification of the lesion as a
primary lacrimal gland tumor will allow them to plan surgical
excision pending histology for proper classification.2,12
Key features of primary lacrimal gland neoplasms
Pleomorphic adenoma:
tightly clustered benign epithelial
cells and characteristic mucinous chondroid matrix;
Adenoid cystic carcinoma:
cells forming characteristic
rosettes and surrounding magenta basement
membrane material; and
Adenocarcinoma:
glands lined by atypical cells contain-
ing mucin.
Eye
There are various techniques for obtaining intraocular cellular
material for cytologic examination. Aqueous or vitreous may be
aspirated or removed with special instruments. Some authors
approach ocular tumors by noninvasive imaging techniques for
localization and then aspirate with a very thin needle (25 gauge
or smaller).68 Several different techniques for fine-needle aspira-
tion including a direct technique through the sclera with the
tumor visualized by transillumination have been described.69
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