K K Khurana1, A J Mortelliti. 1. Department of Pathology, SUNY Upstate Medical University Hospital, Syracuse, NY 13210, USA. Khuranak@upstate.edu
Abstract
BACKGROUND: The current recommendation for the management of juvenile hemangiomas (JH) is to delay treatment in the hope of spontaneous regression. However, accurate diagnosis is necessary before considering conservative management. Traditionally, the diagnosis of JH has required excisional biopsy. The cytology literature on this relatively rare neoplasm is sparse. OBJECTIVE: To present our experience with fine-needle aspiration in the diagnosis and management of JH. DESIGN: Three cases with a cytologic diagnosis consistent with JH of the parotid gland and cheek were identified from our cytopathology files. Aspirate smears, immunohistochemical studies, computed tomographic scan findings, and clinical follow-up were reviewed. RESULTS: Patients were female infants ranging in age from 3 to 9 months and presented with an oval firm mass (size range, 2.0-5.0 cm) involving the parotid gland (2 cases) and cheek (1 case). Computed tomographic scan with contrast demonstrated homogeneous enhancement. Aspirate smears revealed spindle-shaped cells in sheets and clusters in a background of blood. The parotid gland aspirates and cell block preparations revealed ductal structures entrapped in sheets of spindle-shaped cells. Immunohistochemical studies revealed prominent vascular spaces lined by CD34 and factor VIII-positive flattened endothelial cells. The diagnosis of JH was rendered on the basis of the cytologic findings in conjunction with the radiologic and clinical findings. On clinical follow-up (8-24 months), none of the patients has shown any progression of the lesion. CONCLUSIONS: Fine-needle aspiration, in conjunction with imaging studies, is a useful tool in the diagnosis and management of JH. It eliminates the need for surgical excision for diagnostic purposes and allows for clinical follow-up of patients with JH.
BACKGROUND: The current recommendation for the management of juvenile hemangiomas (JH) is to delay treatment in the hope of spontaneous regression. However, accurate diagnosis is necessary before considering conservative management. Traditionally, the diagnosis of JH has required excisional biopsy. The cytology literature on this relatively rare neoplasm is sparse. OBJECTIVE: To present our experience with fine-needle aspiration in the diagnosis and management of JH. DESIGN: Three cases with a cytologic diagnosis consistent with JH of the parotid gland and cheek were identified from our cytopathology files. Aspirate smears, immunohistochemical studies, computed tomographic scan findings, and clinical follow-up were reviewed. RESULTS:Patients were female infants ranging in age from 3 to 9 months and presented with an oval firm mass (size range, 2.0-5.0 cm) involving the parotid gland (2 cases) and cheek (1 case). Computed tomographic scan with contrast demonstrated homogeneous enhancement. Aspirate smears revealed spindle-shaped cells in sheets and clusters in a background of blood. The parotid gland aspirates and cell block preparations revealed ductal structures entrapped in sheets of spindle-shaped cells. Immunohistochemical studies revealed prominent vascular spaces lined by CD34 and factor VIII-positive flattened endothelial cells. The diagnosis of JH was rendered on the basis of the cytologic findings in conjunction with the radiologic and clinical findings. On clinical follow-up (8-24 months), none of the patients has shown any progression of the lesion. CONCLUSIONS: Fine-needle aspiration, in conjunction with imaging studies, is a useful tool in the diagnosis and management of JH. It eliminates the need for surgical excision for diagnostic purposes and allows for clinical follow-up of patients with JH.