Cytological Diagnosis of Osteoblastoma of Cervical Spine: A Case Report With Review of Literature Suguna Belur Venugopal, M.D., and Sruthi Prasad, M.D.*

Osteoblastomas are rare benign but sometimes aggressive primary bone tumors (1%), usually seen in males in the 2nd decade. Osteoblastomas, occurring in the spine, constitute a medical emergency due to impending cord compression. Hence a rapid and simple diagnostic modality, such as fine-needle aspiration (FNA) plays an important role in clinical decision making. Cytological diagnosis of osteoblastoma is rare. We report a case of a young female patient presenting with a swelling in the left cervical paravertebral region. The X-ray findings were non-diagnostic and the patient was sent for an FNA. Aspiration yielded moderately cellular hemorrhagic smears with plasmacytoid cells, spindle cells, and osteoclastic giant cells in a background of matrix material. A diagnosis favoring osteoblastoma was made. The CT scan findings were in agreement with the cytological diagnosis and the lesion was excised. Histopathological examination confirmed the same. We describe here, the clinical and cytological features of osteoblastoma with their differential diagnosis, along with review of the literature. FNA can be used as an important tool in the preoperative diagnosis of osteoblastoma. Diagn. Cytopathol. 2015;43:218–221. VC 2014 Wiley Periodicals, Inc. Key Words:

osteoblastoma; cervical spine; cytology; FNAC

Fine-needle aspiration (FNA) is becoming a widely used diagnostic modality for the initial diagnosis of various bone lesions, in many medical centers. This is due to its simplicity, cost-effectiveness, and ability to issue a rapid diagnosis, which in turn can facilitate clinical decision making. Knowledge of the cytologic appearance of bone tumors is important because of the speed and low cost of diagnosing them by FNA and also because they may be inadvertently aspirated during the work-up of a metastatic disease from which they can be distinguished. The accu-

Department of pathology, Kempegowda Institute of Medical Sciences, Bangalore 560070, India *Correspondence to: Sruthi Prasad, MD, Department of pathology, Kempegowda Institute of Medical Sciences, Banashankari 2nd stage, Bangalore 560070, India. E-mail: [email protected] Received 4 October 2013; revised 30 March 2014; Accepted 9 May 2014 DOI: 10.1002/dc.23175 Published online 22 May 2014 in Wiley Online Library (wileyonlinelibrary.com).

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racy of FNA in bone lesions can vary from 70 to 90% when the goal is to distinguish benign from malignant lesions; however, it is less accurate for precise subclassification of neoplasms.1 Spinal lesions with threatening cord compression are a medical emergency and FNA can rapidly issue a diagnosis. We report a case of an osteoblastoma of the cervical spine diagnosed primarily on FNA with review of literature.

CASE REPORT A 25-year old lady presented with 3 months history of pain accompanied by restriction of movements and a firm swelling in the left cervical paravertebral region. The initial X-ray was non-diagnostic due to unsatisfactory films. The patient was referred for an FNA. On examination, the left cervical paravertebral region showed a firm to hard, well defined swelling measuring 3.5 cm 3 3 cm. The aspiration yielded moderate amount of hemorrhagic material. The wet fixed smears were stained with hematoxylin and eosin and Papanicolaou stain, while the dry smears were stained with May–Grunwald–Giemsa (MGG). Microscopic examination revealed moderately cellular smears with a background rich in RBCs. Seen was a polymorphous population of cells with scattered plasmacytoid cells, spindle cells, and multinucleate osteoclastic giant cells (Figs. 1 and 2). The plasmacytoid cells were plump and oval with eccentric round nuclei that seem to protrude out of the cells (Figs. 2 and 3). The nuclei had evenly dispersed chromatin and a single prominent nucleolus. The cells were seen embedded in matrix material (Fig. 3). With the aforementioned findings, a cytologic diagnosis of an osteoblastic neoplasm favoring osteoblastoma was made. Following this, a CT scan revealed a slightly expansile sclerotic area in the left paravertebral aspect, altering the posterior morphology of body of the C3 cervical vertebra. Rest of the vertebra and the posterior arch elements were C 2014 WILEY PERIODICALS, INC. V

Diagnostic Cytopathology DOI 10.1002/dc

CYTOLOGY OF CERVICAL OSTEOBLASTOMA

Fig. 1. Moderately cellular smears with spindle cells, plasmacytoid cells, and multinucleate giant cells in hemorrhagic background (H & E, 1003), inset multinucleate cells (4003). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

Fig. 3. Spindle cells in matrix material and hemorrhagic background (H & E, 4003). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

Fig. 2. Spindle cells and plasmacytoid cells in matrix material and hemorrhagic background (H & E, 4003). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

normal. No soft tissue abnormality was detected. A radiological diagnosis suggestive of osteoblastoma was made. Subsequently, the lesion was excised and the histpathological examination of the specimen confirmed the above diagnosis. It showed haphazardly dispersed interconnecting bony trabeculae rimmed by osteoblasts and scattered osteoclasts within a richly vascular stroma (Fig. 4).

DISCUSSION Osteoblastomas are rare benign vascular bone tumors accounting for about

Cytological diagnosis of osteoblastoma of cervical spine: a case report with review of literature.

Osteoblastomas are rare benign but sometimes aggressive primary bone tumors (1%), usually seen in males in the 2nd decade. Osteoblastomas, occurring i...
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