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References

Figure 2. (a) Immunostain of p16 shows nuclear staining (9630). (b) In situ hybridization for high-risk types of human papillomavirus (HPV ISH) performed on the cell block: the signal is seen as punctuated dots within the nuclei of the tumour cells (9400).

develop a second primary tumour. Interruption by the E6 and E7 viral oncogenes of the p53 and retinoblastoma pathways, causing an overexpression of p16, could explain this phenomenon.7 The occurrence of a second different subtype of SCC in a patient originally diagnosed with a conventional SCC of the tongue, and treated with a partial glossectomy, bilateral neck dissection and radiation therapy, can be explained by the biological phenomenon of ‘field cancerization’. It has been hypothesized that carcinogenesis occurs in many cells within a uniformly exposed field, often resulting in multiple separate carcinomas, especially when a history of alcohol and tobacco use is present.8 The status of these risk factors in the current case is unknown. PSCC is usually treated with surgery and has a prognosis that is either comparable or better than that of conventional SCC, despite its tendency for multiple recurrences.4 In summary, the current case report details the cytological and immunocytochemical features of PSCC, a knowledge of which, when used judiciously and in the appropriate clinical setting, can obviate the need for diagnostic surgical excision. It also underscores the role of FNA diagnosis to improve the efficiency of triage and management, minimizing morbidity and delays in diagnosis. R. Cocker*, K. Chau*, C. Gimenez* and W. E. Khalbuss† *North Shore-Long Island Jewish Health System, Lake Success, NY, USA, †University of Pittsburgh Medical Center, Pittsburgh, PA, USA © 2014 John Wiley & Sons Ltd Cytopathology 2015, 26, 388–395

1. Mehrad M, Carpenter DH, Chernock RD et al. Papillary squamous cell carcinoma of the head and neck: clinicopathologic and molecular features with special reference to human papillomavirus. Am J Surg Pathol 2013;37: 1349–56. 2. Krane JF. Role of cytology in the diagnosis and management of HPV-associated head and neck carcinoma. Acta Cytol 2013;57:117–26. 3. Westra WH. Detection of human papillomavirus (HPV) in clinical samples: evolving methods and strategies for the accurate determination of HPV status of head and neck carcinomas. Oral Oncol 2014;50:771–9. 4. Fitzpatrick SG, Neuman AN, Cohen DM, Bhattacharyya I. Papillary variant of squamous cell carcinoma arising on the gingiva: 61 cases reported from within a larger series of gingival squamous cell carcinoma. Head Neck Pathol 2013;7:320–6. 5. Yang CH, Huang CC, Ko MT, Wei YC, Hwang CF. Human papillomavirus infection and papillary squamous cell carcinoma in the head and neck region. Tumour Biol 2013;34:301–7. 6. Suarez PA, Adler-Storthz K, Luna MA et al. Papillary squamous cell carcinomas of the upper aerodigestive tract: a clinicopathologic and molecular study. Head Neck 2000;22:360–8. 7. Xu CC, Biron VL, Puttagunta L, Seikaly H. HPV status and second primary tumours in oropharyngeal squamous cell carcinoma. J Otolaryngol Head Neck Surg 2013;42:36. 8. Fortuna G, Mignogna MD. Oral field cancerization. CMAJ 2011;183:1622.

Fine needle aspiration cytology of malignant solitary fibrous tumour DOI:10.1111/cyt.12218

Dear Editor, Malignant solitary fibrous tumours (SFTs) are rare and poorly understood mesenchymal neoplasms,1 which most often originate as pleural tumours. It is now recognized that this tumour may arise at any site.2,3 SFT is characterized by a branching, haemangiopericytoma-like (staghorn) vasculature, together with both hypercellular and hypocellular collagenized stroma.2–4 Malignant SFT Correspondence Dr P. Dey, Department of Cytology, Postgraduate Institute of Medical Education and Research, 160012 Chandigarh, India Tel.: 0091 172 2755120; Fax: +91 172 2744401; E-mail: [email protected]

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Figure 1. (a) Cohesive clusters of oval to spindle cells [May–Gr€ unwald–Giemsa (MGG) 9240]. (b) Oval to spindle cells with moderate amount of cytoplasm: a mitotic figure is seen (MGG 9440). (c) Oval to elongated cells arranged around capillaries: frequent mitotic figures are seen (MGG 9440). (d) Histological section showing oval to spindle cells (haematoxylin and eosin stain 9240).

is characterized by hypercellularity, at least focal moderate to marked nuclear atypia, tumour necrosis, four or more mitoses per 10 high-power fields and infiltrative margins of the tumour.2 Fine needle aspiration (FNA) cytology of malignant SFT is rarely described.1 Herein, we present one such case. A 19-year-old man presented to our outpatient department with left anterior chest wall swelling for FNA. The 3 9 3-cm2 swelling was soft and fluctuant, and was 6 cm away from an operative scar. As a result of the consistency of the swelling, the clinical diagnosis was considered as lipoma. The patient had a history of chest wall swelling 2 years previously, but at a different site. The lesion was excised and reported as malignant SFT on histology. The patient has been well since then. FNA cytology was performed in the FNA clinic from this superficial swelling with a 23-gauge needle, a 20-cm3 syringe and pistol handle. Both airdried and alcohol-fixed smears were made for May– Gr€ unwald–Giemsa and haematoxylin and eosin stains. Smears were hypercellular with cohesive and crowded tissue fragments having haphazard cell arrangements (Figure 1a). The tumour cells were relatively monotonous, plump spindled cells with blunt-ended and often indented nuclei, epithelioid or round cells, fragile wispy cytoplasm with occasional bare nuclei (Figure 1b). The cells showed moderate nuclear pleomorphism and frequent mitoses (Figure 1c). A few cells had long bipolar elongated cytoplasmic processes. The cells were often embedded in a loose myxomatous matrix or shredded collagenized stroma. A cytological diagnosis of spindle cell tumour consistent with malignant SFT was offered. The previous histopathology slides were reviewed. Microscopic examination showed haemangiopericy-

toma-like vessels with a haphazard arrangement of cells. There were hypo- and hypercellular zones. The mitotic rate was about 8–10 per 10 high-power fields. The tumour cells showed nuclear pleomorphism and tumour necrosis (Figure 1d). Immunohistochemistry of the histological section showed CD34, vimentin and CD99 positivity, and smooth muscle antigen, cytokeratin, epithelial membrane antigen and calretinin negativity. SFT is a relatively uncommon tumour and is usually seen in the pleural cavity. Extrapleural SFTs are located in the head and neck region, mediastinum, pericardium, retroperitoneum or abdominal cavity.1–5 Malignant SFTs are extremely rare tumours and may occur de novo or from a pre-existing benign SFT.2 FNA cytology of malignant SFT is rarely described in the literature.1 The differential diagnosis includes monophasic synovial sarcoma, nerve sheath tumour fibrosarcoma, haemangiopericytoma, liposarcoma, mesothelioma and melanoma. On FNA cytology, the differentiation of malignant SFT from other malignant soft tissue tumours is almost impossible without immunocytochemistry. Cases of SFT are usually positive for bcl2, b-catenin and CD34. It is also difficult to differentiate SFT and malignant SFT on FNA cytology. In the present case, we noted moderate nuclear pleomorphism and frequent mitoses that indicated malignancy. This was an already known case of malignant SFT. Without the past histological diagnosis, it would not have been possible to diagnose this tumour on cytology alone. In conclusion, malignant SFT is an uncommon tumour that can occur at a variety of anatomical sites. On FNA cytology, it is difficult to distinguish from other spindle cell tumours and immunocytochemistry is needed for its diagnosis. © 2014 John Wiley & Sons Ltd Cytopathology 2015, 26, 388–395

Correspondence

A. Khairwa*, P. Dey* and R. Nada† *Department of Cytopathology and Gynaecological Pathology, †Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India References 1. Bishop JA, Rekhtman N, Chun J et al. Malignant solitary fibrous tumour: cytopathologic findings and differential diagnosis. Cancer Cytopathol 2010;118:83–9. 2. Guillou L, Fletcher JA, Fletcher CDM, Mandahl N. Extrapleural solitary fibrous tumour and haemangiopericytoma. In: Pathology and Genetics of Tumours of Soft Tissues and Bone. Fletcher CDM, Unni KK, Mertens F (eds). Lyon: IARC Press; 2002: p. 86. 3. Churg A, Cagle PT, Roggli VL. Solitary fibrous tumour. In: Tumours of the Serosal Membranes, 4th edn. Washington, DC: American Registry of Pathology Press; 2006: p. 299. 4. Gengler C, Guillou L. Solitary fibrous tumour and haemangiopericytoma: evolution of a concept. Histopathology 2006;48:63–74. 5. Yokoi T, Tsuzuki T, Yatabe Y et al. Solitary fibrous tumour: significance of p53 and CD34 immunoreactivity in its malignant transformation. Histopathology 1998;32:423–32.

ulohistiocytoma has not been described previously. Presentation in the paediatric age group is rare and there are no reports of its association with acute lymphoblastic leukaemia (ALL). We present a case of paediatric MCRH associated with B-cell ALL (BALL), whose initial cytodiagnosis was misleading on FNA cytology and could be ascertained only on histopathological examination. A 7-year-old boy, a known case of B-ALL, presented with two skin-coloured papules over the medial aspect of the right forearm and on the dorsum of the left foot during maintenance phase (18 months from the start of induction chemotherapy). Both lesions were 3–4 mm in diameter, non-tender and non-erythematous. There was no evidence of relapsed disease, including lymphadenopathy, organomegaly, mucosal involvement or arthropathy. The haemogram was normal. FNA yielded scanty, particulate material. The smears were stained with May–Gr€ unwald–Giemsa (MGG) and haematoxylin and eosin (H&E) stains, were highly cellular and showed sheets of large, (a)

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Paediatric cutaneous reticulohistiocytoma: a diagnostic challenge on fine needle aspiration DOI:10.1111/cyt.12219

Dear Editor, Reticulohistiocytoma and multiple cutaneous reticulohistiocytosis (MCRH) are benign, possibly reactive, histiocytic proliferations of the skin or soft tissues, and are usually not associated with any systemic disease.1–3 Reticulohistiocytoma is a cutaneous condition that presents as a solitary, firm, dermal subcentimetre skin lesion. It usually occurs in young to middle-aged adults with a slight female preponderance, mainly affecting the head and neck region and the upper trunk. It is known to coexist with certain tumours or vasculitis, and is considered to resolve spontaneously over a period of months to years. Fine needle aspiration (FNA) cytology of reticCorrespondence: Dr N. Gupta, Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India Tel.: +0172-2755114; Fax: +0172-2744401; E-mail: [email protected] © 2014 John Wiley & Sons Ltd Cytopathology 2015, 26, 388–395

Figure 1. (a) Cellular smear showing many large polygonal cells with eccentrically placed nuclei; scattered lymphocytes and occasional multinucleated giant cells are seen in the background. Inset: prominent nucleoli and abundant glassy cytoplasm with fine vacuolations (May–Gr€ unwald–Giemsa 9200; inset 9400). (b) Abundant eosinophilic glassy cytoplasm [haematoxylin and eosin (H&E) 9200]. (c) Welldefined cellular borders, fine chromatin and prominent nucleoli (H&E 9400). (d) Histopathological section showing numerous large, polygonal histiocytic cells having eccentric, round to oval nuclei, vesicular chromatin, prominent nucleoli and abundant homogeneous eosinophilic cytoplasm with a ‘ground glass appearance’; some of the histiocytes show vacuolated cytoplasm (H&E 9400). Inset: strong cytoplasmic positivity of the histiocytic cells for CD68.

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Fine needle aspiration cytology of malignant solitary fibrous tumour.

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