Title: Diagnostic Dilemmas in Cytodiagnosis of Primary Osteogenic Sarcoma
Authors: Vandna Yadav, Sonal Bhati, Aruna Pancharia, Vinod Kumar, Abhay Deshmukh
DOI: http://dx.doi.org/10.18535/jmscr/v3i11.36
Introduction: FNA is not gaining acceptance worldwide by clinicians for diagnosis of primary bone tumors. Osteogenic sarcoma is one of the most common primary malignant bone tumors and predominantly affects children and young adults. Aims and Objectives: The aim of this study was to identify the different cytomorphological features which enable correct diagnosis and to identify the common pitfalls which occur in cytodiagnosis of osteogenic sarcoma. Materials and Methods: A total of 19 cases of histologically confirmed osteogenic sarcoma were retrieved from the records of Pathology department from 2008-2013. Previous cytology smears of these cases were reviewed to determine the usefulness of cytology in diagnosing osteogenic sarcoma. Cases were reviewed for clinical, radiologic, cytologic and histologic features. Results: Of the 19 histologically proven cases of osteosarcoma, fine needle aspirates had been reported as: osteogenic sarcoma (n=5), suspicious of osteogenic sarcoma (n=6) and high grade pleomorphic sarcoma (n=3). The discrepant diagnoses were: de-differentiated chondrosarcoma, chondroblastoma, benign cartilaginous tumor and acute inflammatory lesion (one case each). One case was reported as inconclusive due to non-representative smears. The main reasons for discrepancy were: abundance of chondroid matrix, absence of osteoid, super-added infection and non-representative sampling. Conclusion: Insufficient sampling and regional variations in the morphology of osteogenic sarcoma can cause difficulties in cytodiagnosis. Multiple aspirates from different sites of the lesion are recommended for diagnostic sampling. Cytomorphological smears must always be read in conjunction with clinical and radiological data.
Abstract
