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PubMed1999

Immunoreactivity of prostate-specific antigen in male breast carcinomas: two examples of a diagnostic pitfall in discriminating a primary breast cancer from metastatic prostate carcinoma.

Prostatic-specific antigen (PSA) is regarded as a specific marker secreted by normal and neoplastic acinar epithelial cells of the prostate gland; its detection by immunocytochemistry has been accepted as an indication of metastatic prostate cancer. This is ascribed to the commonly held belief that PSA is not found in extraprostatic tissues. However, this concept has recently been challenged, based on the observations that certain nonprostatic tissues and their neoplasms can also secrete PSA. Such a questionable belief could result in a diagnostic pitfall when using immunostaining for PSA on fine-needle aspiration (FNAC) cytology samples to differentiate metastatic prostate cancer from a primary carcinoma of an extraprostatic organ. In this communication, two cases of primary carcinomas of the male breast are reported in which PSA immunopositivity on FNAC led to the suggestion of a diagnosis of metastatic carcinoma of the prostate. Diagn. Cytopathol. 1999;21:167-169.

Acid Phosphatase↗

PubMed1993

Salivary-type myxoid myoepithelioma of the sinonasal tract: a potential diagnostic pitfall.

A 38-year-old woman presented with otalgia and facial pain. She was found to have a tumour involving the right maxillary sinus and pterygopalatine fossa. Exclusively composed of a myxoid population of spindle and stellate cells within a mucosubstance-rich matrix, it was originally interpreted as a mesenchymal neoplasm. However, immunophenotypic characterization revealed a pure population of salivary-type myoepithelial cells with cytoplasmic co-expression of cytokeratin, vimentin, muscle-specific actin, S-100 protein and glial fibrillary acidic protein. Sinonasal myxoid myoepithelial neoplasia is exceedingly rare and represents a potential diagnostic pitfall.

Adult↗

PubMed1994

Sonography of the fetal gastrointestinal tract: anatomic variants, diagnostic pitfalls, and abnormalities.

Prenatal sonography has the potential to show a wide range of abnormalities in a fetus's gastrointestinal tract. Suspected fetal gastrointestinal abnormalities should be interpreted with caution, however, as the sonographic appearance of a healthy fetus's gastrointestinal tract is variable and there is considerable overlap in the appearances of normal and abnormal fetal bowel. Similarly, pathologic processes originating from organ systems other than the gastrointestinal tract can at times exhibit sonographic patterns remarkably similar to those of dilated bowel. This review examines the sonographic findings of gastrointestinal disorders seen in utero, emphasizing potential diagnostic pitfalls arising from confusion with normal anatomy, anatomic variants, and pathologic processes elsewhere in the fetus.

Congenital Abnormalities↗

PubMed1991

Glutaric aciduria type I. Brain CT features and a diagnostic pitfall.

Serial CT findings in an infant with glutaric aciduria type I (GA-I) are reported. The major CT features were dilatation of the insular cisterns, regression of the temporal lobes, with "bat wings" dilatation of the Sylvian fissures and hypodensity of the lenticular nuclei. CT changes preceded the onset of symptoms by 3 months. An improvement in the temporal lobe atrophy was seen after a period of treatment, coinciding with marked clinical improvement. A peculiar feature was the presence of external hydrocephalus, which diverted the attention from manifestations of the primary disease and thus constituted a diagnostic pitfall. The delineation and recognition of the characteristic radiologic manifestations of GA-I are essential for allowing an adequate radiologist/clinician interaction in diagnosing this inborn error of metabolism.

Amino Acid Metabolism, Inborn Errors↗

PubMed2006

Immunophenotypic overlap between adenoid cystic carcinoma and collagenous spherulosis of the breast: potential diagnostic pitfalls using myoepithelial markers.

Adenoid cystic carcinoma of the breast is a rare neoplasm whose cribriform architecture may mimic invasive cribriform carcinoma, cribriform ductal carcinoma in situ, and collagenous spherulosis. The diagnosis may be even more challenging in needle core biopsies. Immunohistochemical expression of p63 and c-kit distinguishes adenoid cystic carcinoma from invasive cribriform carcinoma and ductal carcinoma in situ. A formal comparison of the immunophenotype of adenoid cystic carcinoma to collagenous spherulosis has not been reported. Of concern is the overlap in myoepithelial markers between these two entities. Both may express S100, smooth muscle actin, and p63. This overlap may cause diagnostic confusion yet is under-emphasized in the literature. The expression profile of newer myoepithelial markers has not been studied in this setting. We evaluated smooth muscle actin, p63, calponin, smooth muscle myosin heavy chain, as well as c-kit, in nine cases of cribriform pattern adenoid cystic carcinoma of the breast in comparison to 12 cases of collagenous spherulosis. Both entities strongly expressed p63 and smooth muscle actin; in adenoid cystic carcinoma, the basaloid myoepithelial-like tumor cells expressed these markers, but the ductular epithelial cells did not. Neither calponin nor smooth muscle myosin heavy chain was expressed in adenoid cystic carcinoma but both were strongly expressed in collagenous spherulosis. Whereas the ductular epithelial cells of adenoid cystic carcinoma were positive for c-kit in all cases, collagenous spherulosis was negative for c-kit. Positive p63 expression by a cribriform breast lesion is not sufficiently specific to confirm a diagnosis of adenoid cystic carcinoma. A broader panel that includes calponin or smooth muscle myosin heavy chain and c-kit is required to exclude collagenous spherulosis in settings in which the distinctive morphologic features that separate these entities are not conspicuously present. Reliance on p63 or smooth muscle actin alone poses a potential diagnostic pitfall in evaluating cribriform breast lesions.

Actins↗

PubMedDate not supplied

Angiosarcoma at unusual sites. A report of two cases with aspiration cytology and diagnostic pitfalls.

BACKGROUND: Angiosarcomas are uncommon soft tissue neoplasms with a predilection for skin and superficial soft tissues. CASES: Two cases of angiosarcoma occurred at unusual sites, the parotid gland and lung. The parotid lesion was characterized by malignant cells present singly, in loose groups, in tight three-dimensional aggregates and in acinar formation initially misinterpreted as an adenocarcinoma. The lung mass showed malignant cells in association with vascular endothelium, suggestive of angiosarcoma. Both cases were negative for Ulex europaeus and Factor VIII-related protein but demonstrated strong immunopositivity for CD31, a highly specific endothelial marker. CONCLUSION: In the absence of vasoformative structures, important diagnostic pitfalls are pseudovascular adenoid squamous cell carcinoma, poorly differentiated adenocarcinoma, melanoma and lymphoma. Immunocytochemical studies and clinical history are essential to the correct diagnosis.

Aged↗

PubMed1994

Iatrogenic spinal epidermoid tumour associated with tuberous sclerosis. A diagnostic pitfall.

We present a case of spinal epidermoid tumour that was probably caused by lumbar punctures. The tumour was detected on MRI in a child with tuberous sclerosis complaining of atypical low back pain. Preoperatively the tumour was considered to be a cystic astrocytoma of ependymoma of the conus terminalis. The association of tuberous sclerosis with a spinal tumour is rare but has been recorded in the literature. The diagnosis was an epidermoid tumour (E.T.). The MRI appearances were unusual for a spinal ET: the signal intensity changes were different from those reported in the literature and the presence of calcification and cavitation has not yet been reported. This case represents a diagnostic pitfall, since both entities were unrelated.

Child↗

PubMed1990

Diagnostic pitfalls associated with amoxapine overdose: a case report.

Amoxapine is a second-generation antidepressant that has been reported to cause seizures, severe acidosis, cardiac dysrhythmias, hypotension, renal failure, coma, and cardiorespiratory arrest in poisoning exposures. This is a report of a previously normal 9-year-old child who presented with generalized tonic clonic seizures that led to an extensive workup for primary generalized epilepsy. Nothing in the patient's history or laboratory test results suggested ingestion of a toxin. It was not until 48 hours after admission, when the child admitted taking several of her mother's amoxapine tablets, that the correct diagnosis was made. Because of the risks and the diagnostic pitfalls associated with ingestion of amoxapine, clinicians should be mindful of the lessons taught by this case.

Amoxapine↗

PubMed2004

Extranodal follicular dendritic cell tumor of the tonsil: report of a diagnostic pitfall and literature review.

Follicular dendritic cell tumor (FDCT) usually arises in the dendritic reticulum cells of the lymph nodes. Extranodal cases are rare; only 24 cases have been reported in the head and neck region, and most are in the oropharynx. Nine cases of primary FDCT of the tonsil have been reported in English-language literature, to which we add the 10th case. This 77-year-old white woman presented with a tonsillar mass that was misdiagnosed as squamous cell carcinoma. She underwent neoadjuvant radiotherapy plus combined oropharyngeal and mandibular resection with radical neck dissection. Eight years later, she presented with dyspnea and was found to have a lung mass with hilar lymphadenopathy. A biopsy specimen was taken from the hilar lymph nodes, and histologic analysis yielded results similar to those found in the original tumor. Immunohistochemical analysis confirmed that FDCT was present at both sites. We wish to highlight this potential diagnostic pitfall because the treatment and prognosis for FDCT are vastly different from the treatment and prognosis for squamous cell carcinoma of the tonsil.

Aged↗

PubMedDate not supplied

Papillary clusters as a diagnostic pitfall in urinary cytology of pseudosarcomatous fibromyxoid tumor of the bladder. A case report.

BACKGROUND: Pseudosarcomatous fibromyxoid tumor (PFT) of the urinary bladder is an uncommon benign lesion that can involve any site in the bladder. Cellular features of PFT of the bladder are exceedingly rare. We describe the urinary cytology in a PFT patient who displayed numerous papillary fragments that suggested a malignant tumor. CASE: A 52-year-old man was seen at the hospital for evaluation of gross hematuria. At cystoscopy, the urologist observed a 3-cm, smooth, polypoid and ulcerated mass extending from the trigone to the bladder neck. Urinary cytology showed many papillary clusters with irregular nuclear margins in the bloody cell background. No spindle cells were noted. Cytology was interpreted as papillary growth, factor transitional cell carcinoma, grade 2-3. A laparotomy with partial resection of the urinary bladder was carried out, and histologically the tumor was composed of spindle, stellate, fibroblastic cells embedded in myxoid stroma with little collagen. Immunohistochemical and ultrastructural studies revealed the fibroblastic nature of the lesion. The final diagnosis was PFT of the bladder on the basis of histologic examination of the resected material. CONCLUSION: Papillary fragments are a diagnostic pitfall in urinary cytology of PFT lesions.

Biomarkers, Tumor↗

PubMedDate not supplied

Cutaneous endometriosis as a diagnostic pitfall of fine needle aspiration biopsy. A report of three cases.

We describe the cytologic features of three cases of cutaneous endometriosis in young women (average age, 27 years); two cases presented as lower abdominal nodules associated with a previous cesarean section scar. The third case presented as a 5 x 4-cm inguinal mass. The smears were generally cellular, consisting of epithelial and stromal fragments. Epithelial cells showed large, hyperchromatic nuclei and moderate amounts of cytoplasm, with considerable nuclear overlapping. The stromal aggregates also showed crowded, overlapping nuclei and scant, admixed, hemosiderin-laden macrophages. These features, combined with isolated cells in the background, made differentiation from metastatic carcinoma extremely difficult. Cutaneous endometriosis can present a diagnostic pitfall on fine needle aspiration, especially in the absence of a previous history of abdominal surgery or established diagnosis of endometriosis.

Adult↗

PubMed2004

Pilomatrixoma: a diagnostic pitfall in fine-needle aspiration biopsies. A review from a small county hospital.

A 10-year-old Hispanic girl presented with a 3-cm mass over her right parotid region. A fine-needle aspiration (FNA) was performed and the preliminary and final diagnoses were "suspicious for carcinoma, possible mucoepidermoid carcinoma." A subsequent computed tomography demonstrated an extra-parotid lesion attached to the skin. The FNA smears were reviewed and the diagnosis of a pilomatrixoma (PMT) was reached. The lesion was excised and the diagnosis of benign PMT confirmed. Pilomatrixomas are uncommon skin adnexal tumors most commonly found in the head and neck area of young adults and children. In 10 years there were 16 PMTs among 60,280 surgical pathology specimens in the pathology files of our 300-bed general county hospital. Pilomatrixoma is recognized as a diagnostic pitfall not only clinically but also on FNA cytology. On the physical examination, the bluish skin discoloration over the lesion so typical of PMT was overlooked. On FNA, the basaloid cells of PMT were mistaken for intermediate cells of mucoepidermoid carcinoma. The presence of anucleated squames was not properly recognized. These are usually absent in mucoepidermoid carcinoma and represent a hallmark of PMT. This case illustrates well the risk of misdiagnosing a pre-auricular PMT as a malignant tumor of the parotid gland.

Biopsy, Fine-Needle↗

PubMed1995

Endometrial cells of the "lower uterine segment" (LUS) in cervical smears obtained by endocervical brushings: a source of potential diagnostic pitfall.

The use of endocervical brushes has led to a generous sampling of both endocervical and "lower uterine segment" (LUS) cells. To an unfamiliar eye, the large fragments of endometrial tissue from the LUS may lead to misinterpretation as endometriosis or glandular malignancy, as happened in our institution when the use of endocervical brush and recognition of LUS cells in cervical smears were limited. Eight cases, cytologically interpreted as such, were proven to be benign following cervical biopsy or endometrial curettage. The nature of LUS cells was recognized only on retrospective review of this cytologic material. However, in recent years, routine use of the endocervical brush resulted in an influx of similar cases referred by the cytotechnologists to the pathologist as glandular atypia. Thus, to get familiarized with the cytomorphology of LUS cells and its diagnostic pitfalls, a prospective study was undertaken. This entailed a review of 62,187 consecutive cervicovaginal smears (women of post-hysterectomy status were excluded) received within a 12-mo period (July 1, 1992-June 30, 1993). A total of 344 smears (0.55%) showed large tissue fragments of branching tubular endometrial glands with and without surrounding stroma. Patients ranged from 14-82 yr of age. History of cervical cone biopsy was noted in nine patients (2.6%). Repeat cervical smear or concurrent endometrial or endocervical biopsy available in 84 patients (24.4%) were negative. LUS cells may be mistaken for endometriosis, epithelial glandular atypia, as well as carcinoma of both endocervical and endometrial origin. In addition to glandular abnormality, LUS cells may also be misinterpreted as that of squamous intraepithelial lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2002

Maxillary odontogenic myxoma: a diagnostic pitfall on aspiration cytology.

A painless, slow-growing cheek swelling in a young male clinically considered a salivary gland mass was aspirated. Cytology smears were hypocellular. The striking feature was abundant myxoid material with a few monomorphic oval cells, interpreted as myxoid variant of pleomorphic adenoma. Subsequent CT scan was suggestive of a malignant tumor but biopsy confirmed it as myxoma. Myxoma of the jaw is a rare benign tumor that has a tendency for bone destruction, invasion into surrounding structures, and a relatively high recurrence rate. Maxillary myxoma is less frequent but behaves more aggressively than in the mandible, as it spreads through the maxillary sinus. Cytologically, it should be differentiated from other tumors showing predominant myxoid change. Awareness of potential diagnostic pitfalls and careful evaluation of clinical and radiological data is necessary to narrow the differential diagnosis.

Adenoma, Pleomorphic↗

PubMedDate not supplied

Inverted papilloma-like sinonasal epithelial hyperplasia, overshadowing underlying sinonasal fibrosarcoma: a diagnostic pitfall.

Proliferating invaginations of the sinonasal epithelium, simulating inverted papillomas, have been mentioned once in the literature as a reactive phenomenon overlying sinonasal fibrosarcomas. These proliferations may be so marked as to make the distinction from inverted papilloma virtually impossible. The possible result is that the examining pathologist's attention might be drawn exclusively to the epithelial component, thus causing him to overlook, especially in a small biopsy, a rather bland but distinctive sarcomatoid component which is located underneath. We report such a case of marked endophytic proliferation of sinonasal epithelium which was interpreted, in the preoperative biopsy, as an inverted papilloma with dense fibrous stroma which later, in the surgical specimen, was found to be a part of a submucosal fibrosarcoma. The diagnostic pitfall is discussed.

Biopsy, Needle↗

PubMed2004

Hormone receptor status and HER2/neu overexpression determined by automated immunostainer on routinely fixed cytologic specimens from breast carcinoma: correlation with histologic sections determinations and diagnostic pitfalls.

Although fine-needle aspiration cytology is a routine procedure for the diagnosis of breast carcinoma, cytologic specimens have rarely been used for evaluation of hormone receptor status and HER2/neu overexpression. In order to compare the biological markers on cytology and on histology, routinely fixed smears of 110 primary breast carcinomas were immunostained for estrogen receptor (ER), progesterone receptor (PgR), and HER2/neu by automated immunostainer and the results were compared with the corresponding histologic sections. ER was expressed in 76 of 110 (69%) cases and PgR was expressed in 51 of 110 (46%). Overexpression of HER2/neu was observed in 30 of 110 (27%) cases. Concordance between cytology and histology was 98% for ER, 95% for PgR, and 100% for HER2/neu. There was no false positive result on smears. Diagnostic pitfalls in determination of hormone receptor status on smears included intratumoral heterogeneity and presence of mucin.

Adult↗

PubMed1992

CT during arterial portography: diagnostic pitfalls.

Computed tomography (CT) during arterial portography (CTAP) is an important technique for evaluating the liver before hepatic tumor resection. With this technique, most tumors are of low attenuation compared with that of enhancing parenchyma. At times, low-attenuation lesions are encountered that represent perfusion abnormalities rather than tumor deposits. These perfusion abnormalities can be categorized as (a) those resulting from improper technique; (b) those extending from hilum to capsule (straight-line sign), with or without an obstructing mass; (c) perihilar and periligamentous abnormalities; (d) subcapsular defects (linear or wedge shaped); and (e) those seen with cirrhosis or regenerating nodules. Adjuvant use of delayed CT, magnetic resonance imaging, and intraoperative ultrasound aids in characterization of these nontumorous defects, thereby improving specificity. The authors conclude that when potential candidates are evaluated for hepatic tumor resection, knowledge of the existence of the various diagnostic pitfalls of CTAP and their imaging characteristics is imperative to avoid inadvertent false results.

Angiography, Digital Subtraction↗

PubMed2005

Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases.

Diagnosis of renal angiomyolipoma (AML) by fine-needle aspiration (FNA) may be difficult because cytological and radiological findings sometimes overlap with renal cell carcinoma (RCC) and liposarcoma. Five FNAs of AMLs were studied. Epithelioid and spindle stromal cells were arranged in loosely cohesive clusters and singly. The chromatin was evenly distributed and bland. Occasionally nuclear atypia was identified. Nuclei were oval to elongated, nucleoli were inconspicuous or absent, naked nuclei were present in three specimens, and intranuclear inclusions were present in two specimens. The cytoplasm was delicate and sometimes finely vacuolated. Adipose tissue was observed in two specimens. Thick-walled vessels, mitoses, and necrosis were absent. Corresponding surgical material showed typical features of AML. In FNA, bland chromatin and inconspicuous nucleoli distinguish renal AML from RCC and liposarcoma. Adipose tissue is not universally present. Cellular atypia in conjunction with overlapping radiological findings with RCC and liposarcoma are potential diagnostic pitfalls. Immunocytochemical (ICC) stains may elucidate the correct diagnosis.

Adenoma, Oxyphilic↗