PART TWO
Diagnostic Cytology
Cytology
Aspirates fro m tuberculous lesions often contain caseous necro-
sis, e p ith e lio id cells, lym phocytes, o th e r m on on uc le a r cells,
and Langhans g iant cells. The lesions o f sarcoidosis contain
e p ith e lio id cells, a few lym phocytes, and occasional m u ltin u -
cleated g iant cells. N o necrosis is seen. G ranulom as fo llo w in g
drug use are noncaseous and characterized b y e p ith e lio id cell
reaction w ith g iant cells and e osinop hils. Infectious granulom as
are o fte n associated w ith systemic g ranulom atosis, and the cyto-
logic diagnosis is based o n fin d in g organism s o r ova. In cases o f
intravenous talc granulom atosis, FN A smears contain strong ly
b irefring ent, p late-like crystals w ith in foreig n b o d y g iant cells
and m on on uc le a r macrophages w h e n exam ined u nd er p olar-
ized lig ht. The crystals are com posed o f hydrous m agnesium
silicate.
Benign Mesenchymal Tumors
Cavernous Hemangioma
Cavernous hem angiom as are c om m o n incid ental finding s at
autopsy o r op eration and are o fte n seen in m ultip arou s w om en,
possibly as a result o f an increase o f circulating estrogenic h o r-
m ones d u ring pregnancy. They appear as circum scribed dark
red nodules m easuring fro m a few m illim e te rs to several cen-
tim eters in diam eter. Patients are u su ally asym ptom atic. The
lesions are com posed o f e n d o th e liu m -lin e d channels supported
b y a fib rous strom a. FN A cytology has been described.18 T he first
a u th o r encountered n in e cases o f cavernous hem ang iom a aspi-
rated by fin e needle, m ost fre q u e n tly in the setting o f m etastatic
w orkup .
Cytology
T he aspirates fro m such lesions are inva ria b ly very bloody, and
FN A smears contain scattered noncohesive groupings o f stro-
m al cells w ith elongated nuclei and p o o rly defined cytoplasm
(Fig. 28.11) . Rare e nd o the lia l cells m ay be seen, b u t th ey are
Fig. 28.11 Cavernous hemangioma of the liver. Stromal cells in loose
groupings, appearing as stripped, spindle-shaped nuclei in the absence of
endothelial or liver cells on an extremely bloody background. FNA smear
(Romanowsky x HP).
u su a lly hard to fin d in FN A smears because no p ro life ra tio n
o f e n d o the lia l cells occurs in such lesions. O n ly i f th e op erator
o f asp iration b iopsy makes certain th a t the needle tip is in the
lesio n and has been checked b y an im aging technique can the
p reviously m en tio n ed cytologic find ing s coupled w ith ra d io -
graphic and clinical presentations be considered to be consist-
ent w ith cavernous hem angiom a. However, i f the aspirator uses
a fin e needle in a ro ta tio n a l m o tio n to cut the lesion, large tissue
fragm ents can be ob tained (Fig. 2 8.1 2 ) .19 T he tissue fragm ents
closely correlated to the histo lo g ic finding s (Fig. 28.1 3 ) and are
diagnostic fo r cavernous hem angiom a.
Key features of cavernous hemangioma
• C T scan: e n h a n c in g le sio n s th a t have characteristic
d y n a m ic features a fte r th e a d m in is tra tio n o f c on trast
m a te ria l; o n n o n e n h a n c e d C T scans, h e m a n g io m a s appear
h y p o a tte n u a tin g re la tive to liv e r.
• E xceed ing ly b lo o d y aspirate c o n ta in in g rare clusters o f
sp in d le m esen c hym al cells.
• O c c a sio n a lly large fra g m e nts o f m esen c hym al tissue w ith
cavernous spaces.
Hepatic Angiomyolipoma
A n g io m y o lip o m a is a benign m esenchym al tu m o r th a t occurs
m ore in the kid n ey th an in the liver. However, the incidence
o f hepatic a ng io m yo lip o m a has been increasing due to the
im p ro ve m e n t in im aging techniques.20 T he m ean age o f hepatic
a ng io m yo lip o m a is 50 years, w ith m arked fem ale predom inance
(80% ). M o st patients w ith hepatic a ng io m yo lip o m a also have
renal ang iom yolip o m a , and a few (10% ) have tuberous sclero-
sis.21 M icroscopically, th e tu m o r consisted o f a peculiar sp in -
dle-shaped and e p ith e lio id neoplastic cells, adipose tissues,
and p ro life ra tin g b lo o d vessels. The p ro p o rtio n o f each o f the
three com ponents varies, resulting in vastly d iffe re n t ra d io -
logic, histolog ic, and cytologic appearances.
Long believed
to be a h am arto m a com posed o f th ic k-w alled b lo o d vessels,
s m o o th muscle, and m ature adipose tissue, a ng iom yolip o m a
Fig. 28.12 Cavernous hemangioma of the liver. Endothelium-lined
cavernous spaces sandwiched fibrous stroma composed of fibroblasts. FNA
smear (Papanicolaou x HP).
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