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Diagnostic utility of arborizing stromal meshwork fragments in mucinous tumors
Author(s) -
Patadji Stell,
Pantanowitz Joshua,
Perlov Natalie M.,
Monaco Sara E.
Publication year - 2016
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.23553
Subject(s) - medicine , mucinous carcinoma , pathology , adenocarcinoma , mucin , mucinous tumor , mucus , fine needle aspiration , biopsy , pancreas , cancer , biology , ecology
Arborizing stromal meshwork fragments (ASMFs) have been proposed as a useful clue to differentiate mucin associated with mucinous adenocarcinoma from contaminating mucus during endobronchial ultrasound‐guided transbronchial needle aspiration. Our aim was to retrospectively review cytology cases with mucinous material to determine the utility of ASMFs in diagnosing mucinous tumors. Material and Methods Diff‐Quik stained smears from archival cytology cases ( N = 40) were reviewed, including adenocarcinomas with mucinous features, cystic mucinous neoplasms, and control cases with mucin contamination. Specimens were procured by image‐guided fine needle aspiration (FNA) (16 cases), endoscopic ultrasound‐guided FNA (22 cases), pathologist‐performed FNA (1 case), and fluid drainage (1 case). All cases were reviewed for ASMFs, which were defined as metachromatic, spidery extensions with frayed edges within a background of mucinous material. Results ASMFs were identified in 4 (10% of cases, 14% of adenocarcinomas) cases of metastatic gastrointestinal mucinous adenocarcinomas in various locations (liver, lymph node, lung, and bone), but absent in mucin contamination. ASMFs in Diff‐Quik stained smears were magenta‐colored and corresponded to intervening stroma between dissecting mucin in the tumor. Nonarborizing desmoplastic stroma, inspissated mucus, cartilage fragments, transgressing vessels in renal cell carcinoma, and mucus‐like material in pancreatic pseudocysts can morphologically mimic ASMFs. Conclusion These data show that ASMFs may be encountered in some (14%) cases of adenocarcinoma with mucinous differentiation. When present, ASMFs can be diagnostically helpful to differentiate adenocarcinoma with mucinous features from contaminating mucus, if reliably distinguished from mimics. Diagn. Cytopathol. 2016;44:805–810. © 2016 Wiley Periodicals, Inc.