J Pathol Transl Med.  2019 May;53(3):192-197. 10.4132/jptm.2019.03.20.

Frozen Cytology of Meningeal Malignant Solitary Fibrous Tumor/Hemangiopericytoma

• Kang M
• Kim NR
• Chung DH
• Yie GT

• KMID: 2449343
• DOI: http://doi.org/10.4132/jptm.2019.03.20

Abstract

A 51-year-old woman presented with severe dizziness. The brain magnetic resonance image revealed a 5.5 cm multiloculated mass with a thick rim in the left temporal lobe. Cytological examination of frozen diagnosis of the mass showed hypercellular sheets of round and rhabdoid cells in a hemorrhagic background, and two mitotic figures were observed. Histologically, the excised dura-based mass consisted of predominantly round cells with small foci of rhabdoid tumor cells in a pseudoalveolar pattern in a hemorrhagic background, and the cells showed nuclear positivity for signal transducer and activator of transcription 6 as well as frequent mitosis. The mass was diagnosed as a grade 3 solitary fibrous tumor (SFT)/hemangiopericytoma (HPC). The cytological diagnosis of SFT/HPC is challenging because of the heterogeneous cytological findings, such as histological heterogeneity, and because there are no standardized cytological criteria for malignant SFT/HPC. Cytological findings, such as singly scattered small cells, hypercellularity, rare ropy collagen, and round and rhabdoid cells with pseudoalveolar pattern, may assist in the diagnosis of malignant SFT/HPC.

Keyword

Solitary fibrous tumors; Hemangiopericytoma; Frozen; Cytology; Central nervous system

MeSH Terms

Brain
Central Nervous System
Collagen
Diagnosis
Dizziness
Female
Hemangiopericytoma
Humans
Middle Aged
Mitosis
Population Characteristics
Rhabdoid Tumor
Solitary Fibrous Tumors
STAT6 Transcription Factor
Temporal Lobe
Collagen
STAT6 Transcription Factor

Figure

• 

  Fig. 1. T2-weighted magnetic resonance imaging reveals a 5.5 cm multiloculated mass (arrow) with a thick hypointense rim.

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  Fig. 2. (A–F) Frozen crush cytology. (A) Cellular smear shows sheets or singly scattered round to oval cells with cellular overlapping. (B) Round- to ovoid-shaped cells have bland nuclear chromatin with a moderate amount of cytoplasm with occasional rhabdoid features. (C) Endothelial cell-lined capillaries crossing the tumor cells. (D) High magnification shows several clusters of oval cells of a pseudoalveolar architecture, coarse chromatin pattern, small inconspicuous nucleoli, and irregular nuclear membranes. Arrow indicates nuclei of endothelial cells. (E) Small round cells (left) and ropy collagenous tails are found. (F) Round to ovoid cells had bland nuclear chromatin with a moderate amount of cytoplasm with occasional rhabdoid features. Inset indicates focal rhabdoid appearance. (G–L) Histological findings. (G, H) Patternless solid growth of spindle to round cells is present with intervening staghorn-like vessels. (I) High magnification shows congested tumor composed of round cells around blood vessels. (J) Pseudoalveolar pattern reveals hypercellularity, pleomorphism, and mitosis (arrow). (K) Congested pseudoalveolar pattern is arranged around blood vessels resembling a pseudorosette-like pattern. Arrow indicates endothelial cells. (L) The tumor cells retain INI-1 immunostainability (left) and nuclear positivity for STAT6 (right).

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  Fig. 3. Electron microscopic findings. (A) Round shaped tumor cells have a moderate amount of cytoplasm filled with intermediate filaments, lysosomes with well-formed Golgi apparatus. Note pinocytotic vesicles (black arrow), intermediate junctions (white arrow) and microvillous processes (× 2,500). (B) Basal lamina-like materials (arrows) surround the tumor cells filled with intermediate filaments (×5,000). (C) Well-formed collagen bundles at the extracellular spaces and cytoplasmic intermediate filaments are found (×3,000).

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