Introduction: Pulmonary spindle cell and mesenchymal lesions are paradox for pathologists due to their rarity, overlapping morphology and differentials ranging from benign to malignant lesions, correct diagnosis is essential due to major treatment implications. This study highlights the role of fine-needle aspiration cytology (FNAC), clot core biopsy/cell block and immunohistochemistry in diagnosis of spindle-cell lesions in lung, thus playing a key role in patient management. Methods: It is a retrospective study of lung FNA with predominantly spindle and mesenchymal cells from 2015-2020 which were classified cytomorphologically into spindle, epithelioid, small round cell and biphasic and IHC panels are applied accordingly. Granulomatous lesions, FNA from mediastinum and chest wall were excluded. Results: 60 cases of lung FNA with spindle and mesenchymal cells were identified and included 6 benign and 54 malignancies which included 24 primary pulmonary and 30 metastases. Most common primary malignancies sarcomatoid carcinoma and most common metastasis was malignant peripheral nerve sheath tumour. FNA was paucicellular in 7 cases, was reported as benign in 7 cases and malignant in 46 cases. There were two false negative cases. One case of pulmonary blastoma was reported as inflammatory pseudotumour on cytology, other case of chondrosarcoma was reported as chondroid tumour. Sensitivity and specificity of FNA in distinguishing benign lesions and malignancies was 93.8% and 100% respectively. Conclusion: FNA along with clot core and IHC plays a pivotal role in the subsequent pathway taken for diagnostic or therapeutic management of these patients without the need for second sampling or trucut biopsies in a low resource setting.


中文翻译：

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肺纺锤体和间质肿瘤的经胸细针抽吸细胞学：潘多拉魔盒

简介：肺梭形细胞和间质病变对于病理学家来说是一个悖论，因为它们罕见、重叠的形态以及从良性到恶性病变的差异，正确的诊断对于重大的治疗意义至关重要。这项研究强调了细针抽吸细胞学（FNAC）、凝块核心活检/细胞块和免疫组织化学在诊断肺部梭形细胞病变中的作用，从而在患者管理中发挥关键作用。方法：回顾性研究2015-2020年以梭形细胞和间质细胞为主的肺FNA，细胞形态学分为梭形细胞、上皮样细胞、小圆细胞和双相细胞，并相应应用IHC面板。肉芽肿性病变、纵隔和胸壁细针穿刺活检被排除。结果：60例肺细针穿刺活检中发现梭形细胞和间质细胞，其中良性肿瘤6例，恶性肿瘤54例，其中原发性肺肿瘤24例，转移性肿瘤30例。最常见的原发恶性肿瘤是肉瘤样癌，最常见的转移瘤是恶性周围神经鞘瘤。FNA 7 例为少细胞，7 例为良性，46 例为恶性。有两例假阴性病例。1例肺母细胞瘤细胞学报告为炎性假瘤，另一例软骨肉瘤报告为软骨样瘤。FNA鉴别良性病变和恶性肿瘤的敏感性和特异性分别为93.8%和100%。结论：FNA 与凝块核心和 IHC 一起在这些患者的诊断或治疗管理的后续途径中发挥着关键作用，而无需在资源匮乏的环境中进行第二次采样或 trucut 活检。