Over the last several years the continually heard mantra "Do More with Less" has kept fine needle aspiration biopsy cytopathology at the forefront of rapid diagnostic procedures for superficial and deep masses. Cytologic criteria have been refined for innumerable diagnoses. The sophisticated use of immunocytochemisty, cytometry, in situ hybridization and other molecular analyses has continued to advance and refine diagnostic accuracy. This conference explores the strengths and limitations of aspiration cytopathology in eight specific situations. Each faculty is well known for his/her expertise in FNA cytopathology and has particular interest and experience in the body site they have chosen for discussion.

Case 1 - Breast

submitted by:
Andrea E. Dawson
Cleveland Clinic Foundation
Cleveland, Ohio

Clinical Summary:

A 75-year-old woman presents with a 9 mm lobulated breast mass on a screening mammogram. An ultrasound is performed that shows that the mass is partially cystic. An ultrasound guided FNA is done and sent to cytology.

Figure 1A

Figure 1B

Case 2 - Thyroid

submitted by:
William C. Faquin
Massachusetts General Hospital
Boston, Massachusetts

Clinical Summary:

A 27-year-old woman presents with a palpable 3.0 cm mass in the right thyroid gland that had been slowly enlarging over the past six months. An FNAB was performed.

Figure 2A

Figure 2B

Figure 2C

Case 3 - Lymph Node

submitted by:
Ann T. Moriarty
Ameripath Indiana
Indianapolis, Indiana

Clinical Summary:

A 73-year-old woman was noted at the time of cardiac catheterization to have bilateral inguinal adenopathy. The adenopathy had been present for several months. The patient denied symptoms of fever or night sweats, but had reported a 15 lb. Weight loss over the past several months. A fine needle biopsy was performed of the left 4x3x3 cm inguinal lymph node.

Figure 3A

Figure 3B

Figure 3C

Case 4 - Soft Tissue

submitted by:
Scott E. Kilpatrick
Women's and Children's Hospital
Chapel Hill, North Carolina

Clinical Summary:

The patient is a 19-year-old man with a soft tissue mass involving the right buttock and lung masses.

Figure 4A

Figure 4B

Figure 4C

Case 5 - Breast

submitted by:
Dr. Andrea E. Dawson
Cleveland Clinic Foundation
Cleveland, Ohio

Clinical Summary:

A 29-year-old woman presents with a smoothly outlined spherical mass on a screening mammogram. An FNA is performed.

Figure 5A

Figure 5B

Case 6 - Thyroid

submitted by:
Dr. William C. Faquin
Massachusetts General Hospital
Boston, Massachusetts

Clinical Summary:

An 86-year-old woman presents with an 8.0 cm right thyroid mass. An FNAB was performed.

Figure 6A

Figure 6B

Figure 6C

Case 7 - Lymph Node

submitted by:
Dr. Ann T. Moriarty
Ameripath Indiana
Indianapolis, Indiana

Clinical Summary:

The patient is a 42-year-old male who presented with a painful right mandible and submandibular area. He had a firm, fixed, "woody" infiltration of the skin and soft tissue overlying the entire right mandible. A CT scan of the mandible demonstrated a 4.4 x 1.8 cm mass extending along the lingual aspect of the anterior right hemimandible, without direct osseous extension. There was enlargement of the right mental foramen and the inferior alveolar nerve.

Figure 7A

There were also two enlarged lymph nodes, one in the submental triangle and one high in the superior cervical chain. The patient denied fevers, weight loss, night sweats or other adenopathy. A fine needle biopsy was performed.

Figure 7B

Figure 7C

Figure 7D

Case 8 - Soft Tissue

submitted by:
Dr. Scott E. Kilpatrick
Women's and Children's Hospital
Chapel Hill, North Carolina

Clinical Summary:

The patient is a 20-year-old male graduate student with a right axillary "lymph node".

Figure 8A

Figure 8B

Figure 8C