Abstract
Background and Objectives: The malignant round cell tumors (MRCT) comprises a group of tumors with a variable histogenesis & biological behavior. Various ancillary investigative techniques have been applied to achieve the diagnosis of MRCT. This study was carried out to confirm the diagnosis of small round cell tumors (SRCT) on FNAC smears using ICC.
Methods: 25 cases were selected irrespective of any age and sex during the year 2005 to 2006. Fine needle aspiration cytology was performed on the lesion after informed consent from patients. Based on the preliminary diagnosis of malignant small round cell tumor on light microscopy additional specimen were obtained for ICC studies. The results were compared with the cytogenetic and histopathology studies.
Results: A total a 25 cases were studies. ES/PNET (14 cases) were the maximum number of cases studied. The cytomorphological diagnosis was confirmed by immunocytochemistry in 76% cases (19 of 25 cases) and revised the diagnosis 8% (2 of 25 cases) cases. The ICC results correlated well with the cytogenetic analysis results, agreement was seen in 11 of the 15 cases which had both ICC & cytogenetic analysis done (73.3%).5 of the 9 cases which had both ICC & excision biopsy done showed correlation (55%).
Conclusion: Immunocytochemistry aided in the confirming of cytological findings. Invasive open biopsies can be avoided there by reducing the trauma to the patient Therefore immunocytochemistry on FNAC smears needs to be included in the list of investigation for the diagnosis of malignant small round cell tumors.
Keywords: FNAC, SRCT, Immunocytochemistry, Ewing Sarcoma/PNET, cytogenetics.
References
- Kim Devoe, Noel weidner: Immunohistochemistry of Small Round-cell tumors. Semin Diagn Pathol 2000; 17:216-224
- Urmil Brahmi, Radhika Srinivasan, Harbhajan SINGH Komal, Kusum Joshi, Subhash Kumari Gupta, Arind Rajwanshi: Comparative Analysis of Electron Microscpy and Immunocytochemistry in the cytologic Diagnosis of Malignant Small round cell tumors. Acta cytol 2003; 47(3):443-449.
- Chang, Chin-Yang Li, Smithson, W.A: Immunocytochemical study of Small round cell tumors in Routinely Processed Speciments Arch Pathol Lab Med 1989: 113:1343-1348.
- B.E., Slagel D.D., Elsheikh T.E, : Diagnositic utility of MIC -2 Immunocytochemical staining in the differential diagnosis of Small Blue cell Tumors. Diagn cytopathol 1998 ; 19 (6) : 410-416.
- Joshi V., Balarezo F., John Hicks, Tsongalis G J; Review Approach to Small round cell tumors of Childhood. Pathology Case reviews 2000; 5 (1) : 26-49.
- McGahey B.E., Moriarty A.T Nelson W.A., Fine-Needle Aspiration Biopsy of Small Round Blue Cell Tumors of Childhood. Cancer 1992: 69 (40:1067-1073.
- Saho K. Pai RR, Khadilkar, UIN : Fine Needle Aspiration Cytology of the Ewing Sarcoma Family of Tumors. Actal Cytol 2000; 44 (3): 332-336.
- Brahmi U, Rajwanshi .A, Joshik, Ganguly NK, Vohra. H, Gupta, SK; Role of immunocytochemistry and DNA Flow cytometry in the Fine Needle Aspiration Diagnosis of malignant Small round cell tumors. Diagn cytopathol 2000;24 (4):233-238.
- Das DK, Bhambhani .S, Chachra K.L., Murthy NS: Small round cell tumors of the Abdomen and Thorax Role of fine needle aspiration cytologic features in the diagnosis and differential diagnosis, Acta Cytol 1996;41(4) : 035 – 1047.
- Cohn SL: Diagnosis and Classification of the Small Round-Cell Tumors of Childhood. Patholgoy 1999; 155:11-15
- Silverman JF, Dabbas DJ, Ganick DJ, Geisinger K R: Fine Needle Aspiration Cytology of Neuroblastoma, Including Peripheral Neuroectodermal Tumor with immunocytochemical and utrasturctural confirmation. Acta cytol 1988; 32 (3) : 367-376.
- Jelen M., Wozniak U: Cytologic Appearance of Esthesionuroblastomas in a fine needle aspirate Acta Cytol 1988;32 (3):377- 380.
- Neuhol N, Artlieb U, Wimmer M, Krisch I: Aspiration Cytology, Immunocytoc-hemistry and electron microscopy of a malignant peripheral neuroectodemal tumor A case report Act cytol 1989; 33 (1) : 74-79.
- Antonius S H, Jongde, Heerde PV ; Fine Needle Aspiration Biospy diagnosis of rhabdomyosascomia An Immunocytochemical Study. Acta cytol 1987; 31(5);573-577.
- Silverman JF, Berus A, Joshi V: Fine Needle Aspiration Cytology of Primitive Neuroectodermal Tumors A report of Three Cases. Acta cytol 1992:; 36(4) : 541-550.
- Otal-Salaverri C, Compora R.G. Vazques A H, Davidson H G: Retroperitoneal Ganglioneuroblastoma Report of a case Diagnosed by fine needle aspiration cytology and electon microscopy. Acta cytol 1989;33(1):80-84.
- Gupta RK, Alausari A G: Fine needle aspiration cytodiagnosis in a cases of hepatoblastoma. Diagn cytopathol 1994;5:114-117.
- Elison DA, Silverman JF, Straubauch PH, Joshi V: Role of Immunocytochemistry, Electron Microscopy and DNA analysis in Fine Needle Aspiration Biopsy Diagnosis of Wilms Tumor. Diagn Cytopathol 1996;14(2):101-107
- Ravindra S, Kini. U: cytomorphology and morphometry of small round cell tumors in the Region of the kidney. Diagn Cytopathol 2005; 32(4):211-216.
- Mierau GW, weeks DA, Hicks MJ; Role of Electron Microscopy and other Special Techniques in the Diagnosis of childhood Round Cell Tumors. Human Pathol 1998 ; 29 (12):1347-1355.
- Beustein M, Kovar H, Paulussen M, Juergensy H: Ewing Sarcoma family of tumors: Current Management Pediatric oncol 2006-22:210-230.
- Carpentieri DF. Qualman sj, Knaussz T: Protocol for the examination of specimens from pediatric and Adult Patients with osseous and Extra Osseous Ewing sarcoma Family & Tumors including Peripheral Primitive Neuroectodermal Tumor and Ewing Sarcome. Arch Pathol Lab Med 2005: 129: 866-880.
- Mallone M: Soft tissue tumors in childhood. Histopathol 1993;23:203-216
- Folpe AL, Rubin BP, Weiss SW: Morphologic and Immunophenotypic Diversity in Ewing family tumors a study of 66 genetically confirmed cases. Am J Surg Pathol 2005;29(8):1025-1033.
- Ushigoma S, Shimoda T, Takaki K, I shikawa E, Marlan J: Cancer 1989: 64:52-62.
- Wombart Bosch A, Contesso G : Histology Immunohistochemistry and Electron Microscopy of Small round cell tumors of Bone Semin Diag Pathol 1996; 13(3):149-169.
- Rosa Noguera: Cytogenetics and Tissue culture of Small round cell tumors of Bone and Soft Tissue, Semin Diag Pathol 1996;13(3): 171-183.
- Amore EG, Ninfo V: Soft tissue Small round cell tumors : morphological Parameters Semin Diag Pathol 1996; 13(3): 184-203.
- Meiss-Kindblom JM, Stevman G, Kindbsom LG: Differntial Diagnosis of Small round cell tumors, Semin Diag Pathol 1996; 13 (3):213-241.
- Terrier P, Wombart Bosch A, Contesso G: Small Round Blue Cell Tumors in Bone: Prognostic Factors correlated to Ewing sarcoma and Neuroectodermal Tumors Semin Diag Pthol 1996;13(3);250-257.
- Flarsharan K.S, Silvermand JF: Paediatric Tumors chap 17 in : Orell SR, Steerett GF, Whitaker D, Eds, Fine Needle Aspirtion Cytology, 4th Edition, Churchill Livingstone 2005:445-468.
- Brown FM : Soft Tissue chap 16: In cytology, Diagnostic Principles and Clinical correlates, 2nd edition, Edmund.S, Cibas, Ducatman B.S. Saunders company 2003: 423-456.
- Jambhakar NA, Bagwan IN, Ghule P, Chinory RF, Agaral S, Kadam PS: Comparative Analysis of Routine Histology, Immunohistochemistry, Reverse Trscriptase Polymerease Chain Reaction and Fluorescence In situ Hybridization in Diagnosis of Ewing Family of Tumors. Arch pathol Lab Med 2006; 130(12): 1813-1820.
- Jambhekar NA, Kadam PS, Chinoy RF: The utility of ancillary studies in pediatric Fine Needle aspiration Cytology Diagn Cytoplathol 1992; 8: 137-147.
- Rosai Juan : Soft tissues chap 25: In Rosai and Ackerman’s Surgical pathology, 9th edition,. Rosai J. Mosby company 2005:2237-2372.
- Rosai Juan: Bone and Joints chap 24: In Rosa and Ackerman’s Surgical pathology, 9th edition, Rosai J, Mosby company 2005:2137-2236.
Corresponding Author
Ashwini Nargund
Department of Pathology, Division of Cytology,
Kidwai Cancer Institute, Bengaluru