<\/a><\/p>\n Other Body Sites Introduction<\/strong><\/p>\n This section deals with fine needle aspiration biopsies (FNAB) from kidney, adrenal gland, gonads, bone and soft tissue.<\/p>\n Kidney FNAB<\/strong> FNAB of renal tumors is reported to have a sensitivity of 79-92% a specificity of 92-99% and an overall diagnostic accuracy of 73-95%. Due to tumor heterogeneity and the importance of cytogenetic classification, definitive diagnosis for some renal neoplasms is best rendered on the histologic specimen. Some Hale’s colloidal iron negative oncocytic neoplasms may be difficult to further subtype on FNAB, and only a differential diagnosis should be rendered as a result.<\/p>\n In adults, the most common non-neoplastic cause of a renal mass is a renal cyst. Other lesions may include an abscess and xanthogranulomatous pyelonephritis. Among the renal neoplasms, the most common benign entity is oncocytoma and the most common malignant entity is a renal cell carcinoma (RCC). Other neoplasms include benign angiomyolipma and renal pelvis urothelial carcinoma.<\/p>\n Cytology of Kidney FNAB <\/strong><\/p>\n Kidney, normal glomerulus Kidney, proximal convoluted tubules Figures 2-3:<\/strong> Tubules and sheets of cells without well defined cell borders. Cytoplasm is ill-defined and fragile. Note abundant granular cytoplasm and bland nuclei.<\/p>\n Kidney, oncocytoma Kidney, oncocytoma Kidney, oncocytoma Kidney, oncocytoma Figures 6-7:<\/strong> Small uniform nuclei with binucleation, smooth nuclear contours, inconspicuous nucleoli. Sharp well-defined cell borders. Abundant uniformly granular cytoplasm, without vacuoles.<\/p>\n Kidney, renal cell carcinoma Kidney, renal cell carcinoma Kidney, renal cell carcinoma Kidney, renal carcinoma Adrenal FNAB<\/strong> In adults, the most common neoplasm in the adrenal gland is a metastasis from lung, or breast. Other frequent sites of origin include the gastrointestinal tract, pancreas, kidney and skin (melanoma). Adrenal primary neoplasms include those of cortical origin (adenoma, carcinoma) and those of medullary origin (pheochromocytoma). Other primary adrenal lesions include myelolipoma, cysts and cortical nodular hyperplasia.<\/p>\n Cytology of Adrenal FNAB<\/strong><\/p>\n Adrenal gland, normal cortex Adrenal gland, normal cortex Adrenal gland, benign cortical nodule Adrenal gland, benign cortical nodule Adrenal gland, pheochromocytoma Adrenal gland, pheochromocytoma Figures 16-17:<\/strong> Loose clusters of polygonal cells with variation in nuclear size and shape. Rare spindle cells.<\/p>\n Adrenal gland, Pheochromocytoma Adrenal gland, Metastatic adenocarcinoma Adrenal gland, Metastatic adenocarcinoma Adrenal gland, Metastatic adenocarcinoma Figures 20-21:<\/strong> Malignant nuclear features including irregular nuclear membranes, parachromatin clearing, coarse chromatin, and irregular nucleoli. Prominent intracytoplasmic vacuoles indent nuclei, indication of glandular differentiation.<\/p>\n
\nMichele M. Weir, MD, FRCP <\/em><\/p>\n
\nFNAB of a renal mass is an uncommon procedure, since most patients with a renal mass go directly to resection. However, FNAB does play a role in the evaluation of a renal mass when:<\/p>\n\n
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\nfor an enlarged view.<\/strong><\/p>\n
\n![\"Image](\"\/gallery\/images_large\/slide1221.jpg\" "\\"Click")
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\nCellular globular capillary loops with spindled and round cells, without atypia.
\n20x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, normal glomerulus<\/strong>
\nCellular globular capillary loops with spindled and round cells, without atypia.
\n20x<\/div>\n
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\nTubules and sheets of cells without well defined cell borders. Cytoplasm is ill-defined and fragile. Note abundant granular cytoplasm and bland nuclei.
\n40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, proximal convoluted tubules<\/strong>
\n40x<\/div>\n
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\n<\/strong>
\nKidney, proximal convoluted tubules
\nTubules and sheets of cells without well defined cell borders. Cytoplasm is ill-defined and fragile. Note abundant granular cytoplasm and bland nuclei.
\n40x<\/div>\n<\/div>\n
\n<\/strong>
\nKidney, proximal convoluted tubules<\/strong>
\n40x<\/div>\n
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\nLow power demonstrates clean background and dyshesion, with single cells and small loose clusters. Note absence of bare stripped nuclei.
\n20x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, oncocytoma<\/strong>
\nLow power demonstrates clean background and dyshesion, with single cells and small loose clusters. Note absence of bare stripped nuclei.
\n20x<\/div>\n
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\nSingle cell dyshesion prominent, with small loose clustering of tumour cells. Abundant granular cytoplasm without vacuoles present.
\n40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, oncocytoma<\/strong>
\nSingle cell dyshesion prominent, with small loose clustering of tumour cells. Abundant granular cytoplasm without vacuoles present.
\n40x<\/div>\n
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\nSmall uniform nuclei with binucleation, smooth nuclear contours, inconspicuous nucleoli. Sharp well-defined cell borders. Abundant uniformly granular cytoplasm, without vacuoles.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, oncocytoma<\/strong>
\n60x<\/div>\n
\n<\/a><\/p>\n
\nSmall uniform nuclei with binucleation, smooth nuclear contours, inconspicuous nucleoli. Sharp well-defined cell borders. Abundant uniformly granular cytoplasm, without vacuoles.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, oncocytoma<\/strong>
\n60x<\/div>\n
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\nConventional type. Low power demonstrates cohesive monolayered sheets with clean background. Small endothelial cells lining capillaries are apparent in group.
\n20x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, renal cell carcinoma<\/strong>
\nConventional type. Low power demonstrates cohesive monolayered sheets with clean background. Small endothelial cells lining capillaries are apparent in group.
\n20x<\/div>\n
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\nConventional type. Monolayered sheets of foamy vacuolated cells with low N\/C ratios, eccentric nuclei, minimal nuclear atypia and small nucleoli. Nuclei appear uniform.
\n40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, renal cell carcinoma<\/strong>
\nConventional type. Monolayered sheets of foamy vacuolated cells with low N\/C ratios, eccentric nuclei, minimal nuclear atypia and small nucleoli. Nuclei appear uniform.
\n40x<\/div>\n
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\nConventional type. Cluster of foamy vacuolated cells with eosinophilic intracytoplasmic Mallory-like bodies.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, renal cell carcinoma<\/strong>
\nConventional type. Cluster of foamy vacuolated cells with eosinophilic intracytoplasmic Mallory-like bodies.
\n60x<\/div>\n
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\nConventional type. More nuclear atypia is apparent with prominent nucleoli, larger nuclei with variation in nuclear size.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nKidney, renal carcinoma<\/strong>
\nConventional type. More nuclear atypia is apparent with prominent nucleoli, larger nuclei with variation in nuclear size.
\n60x<\/div>\n<\/div>\n
\nFNAB of an adrenal mass is usually performed to confirm a metastasis, or in the work-up of an incidental nodule. A functional, or suspected pheochromocytoma is a contraindication for FNAB due to possible hypertensive crisis and\/or death. FNAB of adrenal tumors is reported to have a sensitivity of 85-94% and for metastases, a specificity of 100%.<\/p>\n\n
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\nAbundant foamy granular lipid rich background appears in clumps on thin layer. Entrapped vacuolated cells with round bland regular nuclei. Note bare stripped nuclei as well.
\n40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, normal cortex<\/strong>
\nAbundant foamy granular lipid rich background appears in clumps on thin layer. Entrapped vacuolated cells with round bland regular nuclei. Note bare stripped nuclei as well.
\n40x<\/div>\n
\n<\/a><\/p>\n
\nClusters of vacuolated cells with bland round smoothly contoured nuclei, small nucleoli and fragile frayed cytoplasmic edges.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, normal cortex
\n<\/strong>
\nClusters of vacuolated cells with bland round smoothly contoured nuclei, small nucleoli and fragile frayed cytoplasmic edges.
\n60x<\/div>\n
\n<\/a><\/p>\n
\nAbundant foamy lipid rich background. Entrapped foamy vacuolated cells and bare nuclei. Note round regular bland nuclei.
\n40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, benign cortical nodule
\nAbundant foamy lipid rich background. Entrapped foamy vacuolated cells and bare nuclei. Note round regular bland nuclei.
\n40x<\/div>\n
\n<\/a><\/p>\n
\nClusters of small cells with bland round regular nuclei, small nucleoli and fragile cytoplasmic edges. Foamy granular material in adjacent background.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, benign cortical nodule<\/strong>
\nClusters of small cells with bland round regular nuclei, small nucleoli and fragile cytoplasmic edges. Foamy granular material in adjacent background.
\n60x<\/div>\n
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\nLoose clusters of polygonal cells with variation in nuclear size and shape. Rare spindle cells.
\n40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, pheochromocytoma<\/strong>
\n40x<\/div>\n
\n<\/a><\/p>\n
\nLoose clusters of polygonal cells with variation in nuclear size and shape. Rare spindle cells.
\n40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, pheochromocytoma<\/strong>
\n40x<\/div>\n
\n<\/a><\/p>\n
\nPolygonal cell with fibrillary cytoplasm, binucleation and dusty melanin intracytoplasmic pigment.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, Pheochromocytoma<\/strong>
\nPolygonal cell with fibrillary cytoplasm, binucleation and dusty melanin intracytoplasmic pigment.
\n60x<\/div>\n
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\nProminent 3-D cell ball formation without intercellular windows indicating glandular differentiation.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, Metastatic adenocarcinoma<\/strong>
\nProminent 3-D cell ball formation without intercellular windows indicating glandular differentiation.
\n60x<\/div>\n
\n<\/a><\/p>\n
\nMalignant nuclear features including irregular nuclear membranes, parachromatin clearing, coarse chromatin, and irregular nucleoli. Prominent intracytoplasmic vacuoles indent nuclei, indication of glandular differentiation.
\n40x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, Metastatic adenocarcinoma<\/strong> 40x<\/div>\n
\n<\/a><\/p>\n
\nMalignant nuclear features including irregular nuclear membranes, parachromatin clearing, coarse chromatin, and irregular nucleoli. Prominent intracytoplasmic vacuoles indent nuclei, indication of glandular differentiation.
\n60x<\/p><\/div>\n<\/div>\n
\n<\/strong>
\nAdrenal gland, Metastatic adenocarcinoma<\/strong>
\n60x<\/div>\n