Liu K, Layfield L J
Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
Acta Cytol. 1999 May-Jun;43(3):407-15. doi: 10.1159/000331089.
To present the cytomorphologic features of angiosarcomas identified on fine needle aspiration biopsy, review the literature, and discuss the differential diagnosis and pitfalls involved in such cases.
Fine needle aspirate smears from 11 cases (1 hepatic, 3 breast and 7 subcutaneous/soft tissue lesions of angiosarcomas from eight patients were reviewed. All cases had histologic confirmation of angiosarcoma.
All aspirates were hypocellular, with predominantly single cells in a background of moderate to abundant amounts of blood. Nine cases had scattered inflammatory cells, primarily neutrophils, in the background. Six of the cases had rare small clusters of cells. The cells were oval, round or spindled, with eccentric, round to spindle-shaped nuclei and moderate to abundant amounts of pale blue-gray, vacuolated cytoplasm. The cells ranged from two to nine times the size of the background red blood cells. In four cases, malignant cells demonstrated intracytoplasmic hemosiderin deposits. Small nucleoli were identified in five cases, large nucleoli in one case and hyperchromasia in seven cases. Mitotic figures, erythrophagocytosis, acinarlike or vascular structures, and necrosis were not identified in any of the studied cases. In four cases, a definitive diagnosis of angiosarcoma was rendered on the fine needle aspiration specimen. In three other cases, the differential diagnosis remained between angiosarcoma and radiation change.
The presence of scarce single pleomorphic cells in a bloody background should raise the diagnostic possibility of angiosarcoma. A definitive diagnosis of angiosarcoma is often difficult to render due to the paucity of diagnostic cells unless intracytoplasmic hemosiderin deposits can be identified. Multiple aspirations are often needed in order to obtain diagnostic material. In the setting of radiotherapy, it may be impossible to distinguish angiosarcoma from radiation change, and biopsy should be recommended.
呈现细针穿刺活检确诊的血管肉瘤的细胞形态学特征,回顾相关文献,并探讨此类病例的鉴别诊断及陷阱。
回顾了8例患者的11例血管肉瘤细针穿刺涂片(1例肝脏、3例乳腺以及7例皮下/软组织病变)。所有病例均经组织学确诊为血管肉瘤。
所有穿刺涂片细胞量少,背景为中量到大量血液,主要为单个细胞。9例背景中有散在的炎症细胞,主要为中性粒细胞。6例有罕见的小细胞团。细胞呈椭圆形、圆形或梭形,核偏位,圆形到梭形,胞质为中量到大量淡蓝灰色、空泡状。细胞大小为背景红细胞的2至9倍。4例中,恶性细胞可见胞质内含铁血黄素沉积。5例可见小核仁,1例可见大核仁,7例可见核深染。所有研究病例均未发现有丝分裂象、红细胞吞噬现象、腺泡样或血管结构以及坏死。4例在细针穿刺标本上确诊为血管肉瘤。另外3例的鉴别诊断仍为血管肉瘤与放射性改变之间。
血性背景中出现稀少的单一多形性细胞应提高血管肉瘤的诊断可能性。由于诊断性细胞数量少,除非能识别胞质内含铁血黄素沉积,否则往往难以确诊血管肉瘤。通常需要多次穿刺以获取诊断材料。在放疗情况下,可能无法区分血管肉瘤与放射性改变,应建议进行活检。