The role of fine‐needle aspiration cytology in the evaluation of metastatic clear cell tumors

BACKGROUND Clear cell tumors (CCTs) occur as primary neoplasms in a number of anatomic sites. Due to their overlapping morphologic features, these tumors can be challenging for the cytologist, particularly when they present as metastatic lesions. METHODS Forty‐nine fine‐needle aspirations (FNA) of m...

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Bibliographic Details
Published in:Cancer 1999-12, Vol.87 (6), p.380-389
Main Authors: Hughes, Jonathan H., Jensen, Chris S., Donnelly, Amber D., Cohen, Michael B., Silverman, Jan F., Geisinger, Kim R., Raab, Stephen S.
Format: Article
Language:English
Subjects:
Adenocarcinoma, Clear Cell - pathology
Adenocarcinoma, Clear Cell - secondary
Adrenal Gland Neoplasms - pathology
Adrenal Gland Neoplasms - secondary
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Biopsy, Needle
Bone Neoplasms - pathology
Bone Neoplasms - secondary
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - secondary
clear cell carcinoma
Cytodiagnosis
cytopathology
Female
fine‐needle aspiration cytology
Follow-Up Studies
Germinoma - pathology
Germinoma - secondary
Humans
Investigative techniques, diagnostic techniques (general aspects)
Liver Neoplasms - pathology
Liver Neoplasms - secondary
Lung Neoplasms - pathology
Lung Neoplasms - secondary
Lymphatic Metastasis - pathology
Male
Medical sciences
Middle Aged
Miscellaneous. Technology
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - secondary
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Pelvic Neoplasms - pathology
Pelvic Neoplasms - secondary
Peritoneal Neoplasms - pathology
Peritoneal Neoplasms - secondary
renal cell carcinoma
Retrospective Studies
Soft Tissue Neoplasms - pathology
Soft Tissue Neoplasms - secondary
Thyroid Neoplasms - pathology
Thyroid Neoplasms - secondary
Vaginal Neoplasms - pathology
Vaginal Neoplasms - secondary
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Summary:BACKGROUND Clear cell tumors (CCTs) occur as primary neoplasms in a number of anatomic sites. Due to their overlapping morphologic features, these tumors can be challenging for the cytologist, particularly when they present as metastatic lesions. METHODS Forty‐nine fine‐needle aspirations (FNA) of metastatic CCTs from 46 patients (age range, 29–87 years; mean, 64 years) were reviewed retrospectively. In addition to the routine smears and cell block preparations, ancillary studies were performed in selected cases. Clinical and/or histologic follow‐up was obtained for all patients. RESULTS The sites of the 49 FNAs were the lung (12 cases), lymph nodes (9 cases), liver (7 cases), bone (7 cases), soft tissue (4 cases), pelvis (2 cases), adrenal gland (2 cases), pancreas (1 case), thyroid (2 cases), peritoneum (2 cases), and vagina (1 case). Twenty‐seven patients had a previous history of a CCT and the FNA material in these cases was consistent with a metastasis. The primary anatomic sites in these cases were the kidney (20 cases), ovary (2 cases), salivary gland (1 case), and cervix (1 case). On light microscopy, these tumors had a similar appearance and often were indistinguishable. Nineteen patients did not have a prior history of malignancy; 12 of these patients had a concurrent renal mass and the diagnosis of metastatic renal cell carcinoma was made. The anatomic site of origin of seven of the ten remaining tumors (kidney [2 cases], lung [2 cases], ovary [1 case], germ cell [1 case], and endometrium [1 case]) was established through immunocytochemical studies of cytologic material and clinical follow‐up. CONCLUSIONS FNA plays an important role in the diagnosis of metastatic CCT. Cytologic examination, ancillary studies, and clinical information can establish the anatomic site of origin in the majority (95%) of cases, precluding the necessity of obtaining additional tissue. Cancer (Cancer Cytopathol) 1999;87:380–9. © 1999 American Cancer Society. Fine‐needle aspiration is useful in the diagnosis of metastatic clear cell tumors and, when combined with the clinical history and ancillary studies, can establish the anatomic site of origin in the majority of cases.
ISSN:0008-543X
1097-0142
DOI:10.1002/(SICI)1097-0142(19991225)87:6<380::AID-CNCR9>3.0.CO;2-1