FNA Cytology of Soft Tissue and Bone Tumors

FNA Cytology of Soft Tissue and Bone Tumors

Monographs in Clinical Cytology Vol. 22 Series Editor Philippe Vielh Dudelange, Luxembourg

Henryk A. Domanski Lund Charles S. Walther Lund FNA Cytology of Soft Tissue and Bone Tumors 109 figures, 108 in color, and 8 tables, 2017 Basel Freiburg Paris London New York Chennai New Delhi Bangkok Beijing Shanghai Tokyo Kuala Lumpur Singapore Sydney

Monographs in Clinical Cytology Founded 1965 by Georg L. Wied, Chicago, IL Dr. Henryk A. Domanski Department of Pathology Skåne University Hospital SE 221 85 Lund (Sweden) Dr. Charles S. Walther Department of Pathology Skåne University Hospital SE 221 85 Lund (Sweden) Library of Congress Cataloging-in-Publication Data Names: Domanski, Henryk A., author. Walther, Charles S., author. Title: FNA cytology of soft tissue and bone tumors / Henryk A. Domanski, Charles S. Walther. Other titles: Monographs in clinical cytology ; v. 22. 0077-0809 Description: Basel ; New York : Karger, 2017. Series: Monographs in clinical cytology ; vol. 22 Includes bibliographical references and index. Identifiers: LCCN 2017025751 ISBN 9783318060768 (hard cover : alk. paper) ISBN 9783318060775 (eisbn) Subjects: MESH: Soft Tissue Neoplasms--pathology Bone Neoplasms--pathology Biopsy, Fine-Needle Classification: LCC RC280.B6 NLM QZ 340 DDC 616.99/47107--dc23 LC record available at https://lccn.loc.gov/2017025751 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2017 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) www.karger.com Printed on acid-free and non-aging paper (ISO 9706) ISSN 0077 0809 ISBN 978 3 8055 06076 8 e-isbn 978 3 8055 06077 5

Contents VII Preface Domanski, H.A.; Walther, C.S. (Lund) Chapter 1 1 Principles in the Examination and Management of Soft Tissue Lesions Chapter 2 13 Sampling and Preparation Techniques Chapter 3 15 Ancillary Techniques Chapter 4 22 Normal Elements and the Cytologic Features of Reactive Changes in Soft Tissue Chapter 5 25 Adipocytic Tumors Chapter 6 40 Fibroblastic/Myofibroblastic Tumors Chapter 7 61 So-Called Fibrohistiocytic Tumors Chapter 8 64 Smooth-Muscle Tumors Chapter 9 68 Pericytic (Perivascular) Tumors Chapter 10 71 Skeletal-Muscle Tumors Chapter 11 80 Vascular Tumors V

Chapter 12 89 Gastrointestinal Stromal Tumor Chapter 13 92 Nerve Sheath Tumors Chapter 14 103 Tumors of Uncertain Differentiation Chapter 15 122 Undifferentiated/Unclassified Sarcomas Chapter 16 125 Neuroectodermal Tumors Chapter 17 132 Principles in the Examination and Management of Bone Neoplasms; Normal Elements and the Cytologic Features of Reactive Changes in the Bone Chapter 18 139 Osteogenic Tumors Chapter 19 147 Cartilaginous Tumors Chapter 20 161 Ewing Sarcoma Chapter 21 165 Giant Cell Tumor of Bone and Other Giant Cell-Rich Lesions Chapter 22 171 Notochordal Tumors Chapter 23 175 Lymphohematopoietic and Histiocytic Tumors Chapter 24 181 Bone Metastases Chapter 25 183 Bone Lesions Rarely Examined by Fine-Needle Aspiration 186 Subject Index VI

Preface An increasing use of minimally invasive diagnostic procedures together with continuously growing ancillary techniques applied to cytological specimens brought widespread acceptance of using fine-needle aspiration cytology (FNAC) in the diagnosis of soft tissue and bone lesions. While cytological examinations have been used in many centers to follow up on previously treated sarcomas or to confirm soft tissue and bone metastases, in the last decade the primary diagnosis of soft tissue and bone tumors has emerged as an important new target for FNAC. As the first-line approach, cytologic examination most often provides diagnostic information allowing the initiation of treatment or guidance of the continued diagnostic investigation. The purpose of this volume is to describe, illustrate, and summarize the cytological criteria of the most common entities of musculoskeletal tumors and those rare tumors where cytological features have been largely described in case reports and in smaller series. Correlations between cytology and the diagnostic use of ancillary techniques applicable to FNAC, such as immunocytochemical and molecular tests, are detailed on an entity-by-entity basis in order to facilitate the diagnostic workup in the cytological samples. The selection of entities illustrated are based on experience with patients referred to the Sarcoma Centre of the Skåne University Hospital and the illustrations are taken from the considerable cytological material of musculoskeletal lesions, gathered over more than 45 years, which is available in the archives of our institution. This book provides a comprehensive and well-illustrated review of the FNAC of soft tissue and bone tumors that can be used in the everyday practice of pathologists and cytopathologists in the musculoskeletal field. The content will also be of interest to residents and fellows in cytology, as well as orthopedic surgeons, clinical oncologists, and anyone involved in the diagnosis and therapy of patients with soft tissue and bone lesions. Acknowledgements I would like to thank Dr. Måns Åkerman, the pioneer of musculoskeletal cytopathology and former Head of the Department of Pathology at the Lund University Hospital thanks for teaching and inspiring me to pursue soft tissue and bone pathology/cytopathology. Henryk A. Domanski, Lund I would like to thank Dr. Fredrik Mertens for his guidance and help with tumor genetics. Charles S. Walther, Lund We would like to thank Dr. Philippe Vielh and Mr. Thomas Nold for recognizing the need for this monograph, and the editorial staff of Kar ger, particularly Ms. Rebecca Ganz and Mr. Ruedi Jappert, for their excellent administrative assistance during our work on this volume. Henryk A. Domanski and Charles S. Walther, Lund VII