title: Diagnostic pitfalls in fine-needle aspiration biopsy of the mediastinum.
abstract: A retrospective review of 189 fine-needle aspiration (FNA) biopsies of the mediastinum from four university medical centers was performed. Review of Diff-Quick- and Papanicolaou-stained direct smears was performed from a series of 189 FNA biopsies along with surgical pathology correlation obtained in 42% of the cases. There were 28 (14.8%) nondiagnostic or unsatisfactory for diagnosis cases. Of the satisfactory FNA specimens with histologic correlation, 12 cases (6%) were discordant. These errors primarily involve subclassification of small-cell malignancies involving the mediastinum, including a misdiagnosis of small-cell carcinoma for lymphoma. Large-cell lesions that were problematic included the accurate diagnosis of Hodgkin's lymphoma including the separation from non-Hodgkin's lymphoma. Large-cell lymphoma with sclerosis was misinterpreted in two cases due to distortion of cells by the mesenchymal tissue and sparsely cellular smears. In two cases classification of primary germ-cell tumors and separation from metastatic carcinoma was a problem. In general, FNA of the mediastinum is an accurate procedure, but can be challenging in a minority of cases due to sparse cellularity of the lesions and accurate classification of a variety of neoplasms that occur in this region. These 12 discordant cases serve as the basis of our report.
authors.affiliation: Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, North Carolina 27858-4354, USA.
authors.forename: H K
authors.initials: HK
authors.lastname: Singh
authors.forename: J F
authors.initials: JF
authors.lastname: Silverman
authors.forename: C N
authors.initials: CN
authors.lastname: Powers
authors.forename: K R
authors.initials: KR
authors.lastname: Geisinger
authors.forename: W J
authors.initials: WJ
authors.lastname: Frable
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D018288:Carcinoma, Small Cell / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006689:Hodgkin Disease / Q000473:pathology*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology*; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013953:Thymus Neoplasms / Q000473:pathology*