Cytodiagnosis of Scalp Lesions

Abstract

Background: Scalp lesions being easily accessible for aspiration, fine-needle aspiration cytology (FNAC) offers a minimally invasive, rapid pre-operative diagnostic procedure, avoiding the hazards of open biopsy at this vital site. Benign entities in this region may mimic malignancy clinically and radiologically. FNAC helps to plan surgery, ruling out malignancy in the benign cases, and offering typing of the malignant ones. Materials and Methods: A total of 80 palpable scalp nodules were studied regarding their clinical and cytomorphological features, and the value of FNAC in their differential diagnosis. 11 aspirates foun inadequate for interpretation, were excluded from the study. FNAC was performed using a 23 gaug hypodermic needle. Air-dried smears were stained with May-Grunwald-Giemsa and wet fixed (95% ethanol) ones with hematoxylin and eosin and/or papanicoloeu stains. They were classified on cytology into inflammatory, non-neoplastic and neoplastic conditions. The neoplastic lesions were further typed as non-malignant and malignant, the malignancies as primary or secondary. Where possible, the origin of the secondary malignancy was suggested. Results: There were 14 malignant and 55 non-malignant lesions. Non-malignant lesions included keratinous cysts, benign adnexal and mesenchymal tumors, meningioma, tuberculosis, cysticercosis and reactive lymphadenitis. Primary malignancies included osteosarcoma, primitive neuroectodermal tumor, and two squamous malignancies. There were four hematolymphoid malignancies. Metastatic lesions included four from follicular carcinoma thyroid, one each from an adenocarcinoma prostate and a retinoblastoma. Histopathologic diagnosis, available in seven cases, correlated with the cytodiagnosis. Conclusion: FNAC offers rapid diagnosis in scalp lesions, ruling out malignancy in benign conditions and typing of the malignancies

Keywords

• fine needle aspiration cytology
• scalp masses