Siddiqui Noman H, Jani Jigna
Division of Cytopathology, Department of Pathology, University of Illinois Medical Center, Chicago, Illinois 60612, USA.
Diagn Cytopathol. 2005 Sep;33(3):201-4. doi: 10.1002/dc.20335.
Osteosarcoma, a primary malignant tumor of the long bones, frequently metastasizes to the lungs. We report an unusual case of osteosarcoma metastatic to the right adrenal gland in a 37-yr-old male who presented 8 yr after remission with an adrenal mass. A preoperative diagnosis was made by fine-needle aspiration (FNA) biopsy. FNA biopsy revealed pleomorphic oval cells with prominent nucleoli, spindle cells, and giant tumor cells. Diagnostic osteoid was readily seen on smears and was also detected by polarization of cell-block section. Immunocytochemical stains revealed positivity of tumor cells for vimentin and osteonectin. Cytokeratin stains were negative. The cytologic diagnosis of metastatic Osteosarcoma was made, which was later confirmed upon resection of tumor by histology. Although the role of FNA in the diagnosis of primary bone tumors, including osteogenic sarcoma (OGS), remains controversial, this case, however, demonstrates the value of FNA biopsy combined with immunocytochemistry performed on the aspirated material in diagnosing osteosarcoma from an unusual location such as the adrenal gland.
骨肉瘤是长骨的原发性恶性肿瘤，常转移至肺部。我们报告了一例罕见的骨肉瘤转移至右肾上腺的病例，患者为37岁男性，缓解8年后出现肾上腺肿块。术前通过细针穿刺（FNA）活检做出诊断。FNA活检显示有多形性椭圆形细胞，核仁突出，梭形细胞和巨大肿瘤细胞。涂片上很容易看到诊断性类骨质，细胞块切片的偏振光检查也检测到了类骨质。免疫细胞化学染色显示肿瘤细胞波形蛋白和骨连接蛋白呈阳性。细胞角蛋白染色为阴性。做出了转移性骨肉瘤的细胞学诊断，随后通过组织学肿瘤切除得以证实。尽管FNA在包括骨肉瘤（OGS）在内的原发性骨肿瘤诊断中的作用仍存在争议，但该病例证明了FNA活检结合对吸出物进行免疫细胞化学检查在诊断肾上腺等不寻常部位骨肉瘤中的价值。
