29
Pediatric Tumors
and o vo id nuclei; th ey are isom orp hic, coffee bean-shaped, and
have few p ro m in e n t nucleoli. N uclear "g rooves" are freq uent.32
See the key features o f granulosa cell tu m o r in C hapter 12.
Epithelial Tumors
E p ithe lia l tum ors account fo r 2 0 -3 0 % o f ovarian tum ors in
females less th a n 20 years o ld and are alm ost exclusively serous
o r m ucinous and m o s tly u n ila te ra l and benign (90% o f cases).31
Serous Tumors
Serous tu m o rs are a lm ost always u n ilo c u la r w ith lig h t liq u id ,
th in w alls, and scarce o r num erous papillae. T he y o fte n achieve
a great size (> 10 cm ).31
P a p illa ry S e ro u s C y s ta d e n o m a
M icroscopically, p a p illa ry serous
cystadenomas are covered b y a m o n o stra tifie d cubic o r c o lu m -
nar e p ith elia.31 Fine-needle aspirates show sheets o r papillae
fo rm e d b y cubic o r cylind ric e p ith elial cells, som etim es ciliated,
w ith w id e lig h t cytoplasm and ro u n d o r oval nuclei w ith th in
c h ro m a tin and few visib le n u c le o li.32
See the key features o f p a p illa ry serous cystadenom a in
C hapter 12.
B o rd e rlin e S e ro u s C y s ta d e n o c a rc in o m a
B ord erline serous cystadeno-
carcinom a has lo w p o ten tial fo r m alignancy. M acroscopically,
it shows p len ty o f papillae; histolog ically, com plex papillae
and cellular atypia w ith e p ith elial pseudostratification can be
observed, w ith increased num bers o f m itoses, loss o f p olarity,
and nuclear p le o m o rp h ism .31 Fine-needle aspirates are s im ila r
to those o f serous cystadenom a b u t w ith nuclear p leo m o rp hism ,
hyperchrom asia, and p ro m in e n t n u c le o li.32
P a p illa ry S erous C y s ta d e n o c a rc in o m a
Fine-needle aspirates are sim -
ila r to those o f b o rd e rline serous cystadenocarcinom a b u t w ith
less cellular cohesion and isolated cells. Som etim es th ey show
papillae, p leo m o rp hic cells w ith p ro m in e n t nuc le oli, and psam -
m o m a bodies.32
M ucinous Tumors
M u c in o u s C y s ta d e n o m a
M ucinous cystadenomas are freq uently
m u ltilo c u la r w ith cavities containing m ucinous liq u id , have an
even inte rna l surface, and are covered b y c olum nar cells w ith
basophilic lig h t cytoplasm and sm all basal nuclei; strom a is cellu-
la r and som etim es has a thecal appearance.31 Fine-needle aspirates
show b id im en sio na l sheets o f ep ithelial cells, w h ic h are cylindric
w ith eccentric nuclei and lig h t o r vacuolated cytoplasm .32
See the key features o f m ucinous cystadenoma in Chapter 12.
B o rd e rlin e M u c in o u s C y s ta d e n o m a
Low-grade m alig nancy m uc i-
nous tu m o rs show stratifying cell ep ithelia, loss o f nuclear
p olarity, discrete nuclear p leo m o rp hism , num erous m itoses,
and absent strom a l invasion .31 Fine-needle aspirates show three-
d im e nsion al sheets o f cells s im ila r to those o f m ucinous cystad-
enom a b u t w ith p leo m o rp hism and nuclear hyperchrom asia.32
M u c in o u s
C y s ta d e n o c a rc in o m a
M ucinous
cystadenocarcinom a
loo ks s im ila r to b o rd e rlin e cystadenocarcinom a b u t has neo-
plastic strom al invasion.31 Fine-needle aspirates are s im ila r to
those o f b o rd e rline m ucinous cystadenocarcinom a, b u t part o f
the cells are loose and have hig h er p leo m o rp hism , hyperchro-
masia, and p ro m in e n t n u c le o li.32
Other M alignant Tum ors of the Ovary
S m all-cell carcinom as rarely affect the ovaries o f girls and are
confound ed w ith granulosa cell tu m o rs o r w ith o th e r ro u n d cell
m alignancies. D iffe re n tia l diagnosis is m ade w ith im m u n o c yto -
chem istry.31
Male Genital Tract Tumors
There is a lm ost no experience w ith FN A o f testicular tum ors,
and very little in the rest o f the genital tract structures in m ale
children.
T umors of the Skin
C h ild re n can be affected by a great variety o f skin tu m o rs and
pseud otum oral lesions, o fte n o f vascular o rig in, m o s tly benign,
and w ith a p articular m acroscopic appearance. Therefore FN A is
n o t n o rm a lly needed to m ake th e diagnosis.33
Benign Epithelial tumors
Benign e p ith elial tu m o rs w ith pilosebaceous d iffe re n tia tio n are
freq uent in children, especially the in fu n d ib u la r type (kera ti-
nous cysts) o r ep id erm oid type.33 Fine-needle aspirates show
ab und ant corneous flakes, keratin, and scarce keratinized pavi-
m entous cells. W h e n inflam ed , m ultin u clea te d macrophages
can be observed. A m o ng fo llic u la r cysts, derm oids are the m ost
frequent. Fine-needle aspirates are s im ila r to those o f keratinous
cysts. H a ir fragm ents, sebaceous a n d /o r cuboid cells, a n d /o r
b id im e n sio n a l sheets can a d d itio n a lly be observed.
Key features of keratinous cysts
• C o rn e o u s flakes and k e ra tin ;
• K e ra tin ize d p a vim e n to u s cells; and
• S o m e tim e s m u ltin u c le a te d m acrophages.
Pilomatrixoma
P ilo m a trixo m a is the m ost frequent tu m o r o f the pilosebaceous
u n it; it originates in cells o f the pilous m a trix and often affects
children younger than 10 years, fo rm in g a hard and w ell-defined
nod ule in the skin o f the head and neck (Fig. 29.9A,B).33 Fine-
needle aspirates show alternates o f sheets form ed by basaloid and
pavim entous keratinized cells (som etim es anucleated), keratin,
giant m ultinucleated macrophages, fragm ents o f fibrous strom a,
and occasionally sm all fragm ents o f calcic m aterial (Fig. 29.9C).
Key features of pilomatrixoma
• Sheets o f b a sa lo id cells;
• Sheets o f sq ua m ou s k e ra tin iz e d cells;
• A n u cle ate d k e ra tin iz e d cells;
• M u ltin u c le a te d m acrophages; and
• C alcic m a te ria l.
Benign Mesenchymatous Tumors
The m ost freq uent m esenchym atous tu m o rs o f the skin are
hem angiom as, b u t there are also d erm atofibrom as, xanthogran-
ulom as, and neurofibrom as. The rest o f the m esenchym atous
tu m o rs are very infre q ue nt.33 Fine-needle aspirates o f these
lesions are described in the section on soft tissue tum ors.
Malignant tumors
M alignancies o f the skin are infrequent in children, and they can be
etiopathogenically divided in to sporadic, w h ic h are rare o r associ-
ated w ith hereditary tu m o ral syndromes such as fa m ilia l cutaneous
935
previous page 923 ComprehensiveCytopathology 1104p 2008 read online next page 925 ComprehensiveCytopathology 1104p 2008 read online Home Toggle text on/off