Fine-Needle Aspiration Cytology of Epithelioid Hemangioendothelioma: A Study of 12 Cases.
Rajmohan Murali, Matthew A Zarka, Idris T Ocal, Henry D Tazelaar. Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Scottsdale, AZ
Background: Epithelioid hemangioendothelioma (EHE) is a vascular tumor which may arise in lungs, soft tissue, liver and rarely in other anatomic locations. EHE may be difficult to distinguish from epithelial neoplasms, particularly adenocarcinoma, a difficulty compounded in fine-needle aspiration (FNA) specimens. Only isolated case reports of the features of EHE in FNA specimens have been described. We sought to study a series of EHE cases in order to identify characteristic features which might be useful in distinguishing them from other tumors.
Design: Patients with histologically-confirmed EHE who underwent FNA of their tumors between 1994 and 2010 were identified from the institutional database. All available cytologic slides were reviewed and scored where possible. The following features were examined: cellularity; cell arrangement/architecture; cell shape; nuclear location; nuclear grooves; intranuclear pseudoinclusions (INPIs); cytoplasmic appearance; cytoplasmic border; intracytoplasmic lumina (ICLs); presence of erythrocytes within ICLs; and background.
Results: Cytologic slides were available for review in 15 cases (9 female and 6 male patients). The tumors were situated in bone (n=5), soft tissue (n=5), liver (n=4) and lung (n=1). Three cases (2 in soft tissue and 1 in liver) contained insufficient cellular material for cytologic diagnosis. The smears in the remaining 12 cases showed variable cellularity. Architecturally, the smears demonstrated predominantly dispersed single cells along with occasional cohesive cell clusters. The cells were usually epithelioid in shape, with dense cytoplasm, well-defined cytoplasmic borders and eccentrically located nuclei. There was variable nuclear pleomorphism and nuclear grooves were identified in 11 (92%) cases. Occasional mitotic figures were present in 4 cases. At least occasional INPIs and ICLs were present in 11 (92%) cases, and rare erythrocytes were seen within ICLs in 5 cases. The background contained hemosiderin and siderophages in 5 cases.
Conclusions: Although the low power architectural pattern and individual cytologic features of EHE are not unique to these tumors, the combination of the following features: predominantly dispersed single cells with occasional cohesive cell clusters, epithelioid cytomorphology, dense cytoplasm with well-defined cytoplasmic borders, ICLs (± erythrocytes) and INPIs, in FNA samples should raise strong suspicion for EHE. They should prompt immunohistochemical evaluation using vascular markers and clinico-radiologic-pathologic correlation.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 87, Wednesday Afternoon