Fine needle aspiration cytopathology of pleomorphic dermal sarcoma

• Published in: Cytopathology (Oxford) Vol. 34; no. 5; pp. 472 - 478
• Main Authors: Challa, Bindu S., Plaza, Jose A., Wakely, Paul E.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.09.2023
• Subjects: Actin; Aged; Aged, 80 and over; atypical fibroxanthoma; Biopsy; Biopsy, Fine-Needle; Cytology; Cytopathology; dermal sarcoma; Dermis; Fasciitis; fine needle aspiration; Humans; Melanoma; Metastases; Middle Aged; Neoplasia; Sarcoma; Sarcoma - pathology; Skin Neoplasms - diagnosis; Skin Neoplasms - pathology; skin tumour; Smooth muscle; soft tissue; Soft Tissue Neoplasms; Stains & staining; Tumors; Vimentin; soft tissue; dermal sarcoma; skin tumour; cytopathology; fine needle aspiration; atypical fibroxanthoma
• ISSN: 0956-5507; 1365-2303
• DOI: 10.1111/cyt.13248

Introduction Pleomorphic dermal sarcoma (PDS) is an uncommon cutaneous mesenchymal neoplasm. It is cytomorphologically identical to atypical fibroxanthoma (AFX), but differs due to its invasion beyond the dermis. We undertook an examination of our experience with fine needle aspiration (FNA) biopsy cytology of PDS. Materials and Methods Our cytopathology files were searched for examples of PDS with concomitant histopathological verification. FNA biopsy smears and cell collection were performed using standard techniques. Results Seven cases of PDS were retrieved from four different patients (M:F, 1:1; age range: 63–88 years; mean age = 78 years). All patients (57%) presented with a primary tumour with one having an FNA biopsy of two local recurrences and a single distant metastasis. Five aspirates were from the extremities and two from the head/neck. Tumours ranged from 1.0 to 3.5 cm (mean, 2.2 cm). Specific cytological diagnoses were pleomorphic spindle/epithelioid sarcoma (3 cases), PDS (2), AFX (1), and atypical myofibroblastic lesion, query nodular fasciitis (1). Immunohistochemical (IHC) staining from FNA‐generated cell blocks in two cases showed non‐specific staining with vimentin in both cases; positive CD10, CD68, and INI‐1 staining in one case; and smooth muscle actin expression in the other. Multiple negative stains were performed in both of these cases to exclude malignant melanoma, carcinoma, and specific forms of sarcoma. Cytopathology consisted of a mixture of spindle, epithelioid, and bizarre pleomorphic cells. Conclusion Coupled with ancillary IHC stains, FNA biopsy can help recognise PDS as a sarcomatous cutaneous neoplasm, but is unable to distinguish PDS from AFX. Reports of the fine needle aspiration (FNA) cytopathology of pleomorphic dermal sarcoma (PDS) are rare with this being the only series on the subject to date. FNA biopsy smears consist of a mixture of large spindle, epithelioid, and bizarre pleomorphic cells. Distinguishing PDS from atypical fibroxanthoma (AFX) is not possible using FNA biopsy.