Fine-needle aspiration cytology (FNAC) of a soft tissue lesion around the ankle/toes was performed using a 23-gauge needle. The aspirate shows amorphous granular material with cohesive aggregates of needle-shaped crystals possessing pointed tips, consistent with monosodium urate crystals in a gouty tophus. The background contains inflammatory cells and multinucleated giant cells, reflecting a granulomatous reaction to crystal deposition. Stained cytology commonly employs Papanicolaou or Romanowsky stains to highlight needle crystals, which appear slender with sharp ends and may form rosettes or fragile bundles. These features distinguish tophi from other crystal deposits and inflammatory masses. Clinically, this cytologic profile supports a diagnosis of chronic tophaceous gout involving soft tissues around the ankle and digits, particularly in patients with hyperuricemia or prior gout attacks. Differential considerations include calcium pyrophosphate dihydrate (CPPD) crystals (rhomboid shapes), cholesterol crystals, or infectious/inflammatory nodules; however, the characteristic needle-shaped, negatively birefringent urate crystals are highly specific. Diagnostic significance lies in definitive cytologic demonstration of monosodium urate within inflammatory stroma, guiding urate-lowering therapy and anti-inflammatory management. Correlate with serum uric acid, renal function, and imaging studies for comprehensive disease assessment and therapeutic planning; case contributed by Dr. Dhiraj Nikumbh. This case highlights diagnostic utility for aspiration cytology and treatment.

Fine-needle aspiration cytology (FNAC) of a paraspinal soft tissue mass demonstrates cells with voluminous, bubbly cytoplasm and large, bland hyperchromatic nuclei set in a myxoid, occasionally granular background. The cytologic smear is highly cellular, with scattered physaliferous cells featuring vacuolated, sometimes foamy cytoplasm and small-to-moderate nuclei. Many cells appear columnar-oval with a discohesive affinity, and occasional binucleation is seen. The distinctive bubbly cytoplasmic vacuoles and the presence of cartilaginous or chondroid–like matrix support a chordoma diagnosis, though differential includes clear cell renal cell carcinoma and other chondroid neoplasms. The staining used is Giemsa, which highlights the cytoplasmic vacuolization and the delicate, lace-like myxoid stroma around the tumor cells. Overall, the image demonstrates a neoplasm with notochordal differentiation, consistent with chordoma arising in the paraspinal region. Diagnostic significance lies in recognizing physaliferous cells and their abundant cytoplasm, which, in the appropriate clinical and radiologic context, directs confirmation by immunohistochemistry (brachyury positivity) and correlation with imaging to define extent. Differential diagnoses include metastatic RCC, chondrosarcoma, and chordoid variants; immunostaining and radiologic correlation are essential. This cytology image has educational value for surgical pathology, cytology practice, and differential diagnosis training in spine-associated tumors.

Fine-needle aspiration cytology (FNAC) of an abdominal mass was prepared as a conventional smear and stained with Hematoxylin and Eosin (H&E). The smear is moderately cellular, composed of interlacing sheets and fascicles of spindle-shaped and epithelioid cells with elongated to oval nuclei, finely textured chromatin, and occasional small nucleoli. The cytoplasm is variable, pale to eosinophilic, with occasional binucleation; cells are embedded in a prominent inflammatory background containing lymphocytes and plasma cells, with rare macrophages. Mitoses are infrequent; necrosis is not evident. The overall morphology shows a dendritic cell-like constellation with broad cytoplasmic processes and cohesive clusters that can mimic other spindle cell neoplasms. Immunohistochemistry (performed on ancillary material) reveals strong and diffuse CD21 positivity, supporting a follicular dendritic cell lineage. The cytologic features, together with CD21 expression, favor follicular dendritic cell sarcoma (FDC sarcoma) over other spindle cell tumors such as fibrosarcoma, inflammatory myofibroblastic tumor, sarcomatoid carcinoma, or melanoma variants. Clinically, this diagnosis is important because it informs surgical planning and adjuvant therapy considerations and requires correlative histopathology for definitive confirmation. The image documents cytomorphology with dendritic cell-rich background and immunophenotype concordance; additional markers (CD23, CD35) can increase diagnostic confidence in FDC sarcoma.

Fine-needle aspiration cytology (FNAC) of a parotid gland lesion demonstrates cohesive sheets and clusters of oncocytic epithelial cells embedded in a lymphoid-rich background. Diff-Quik stained smears reveal cells with abundant granular eosinophilic cytoplasm, round to oval nuclei with smooth nuclear chromatin, and scant cytoplasm at the periphery; occasional mitoses are absent or rare. The inflammatory background consists of mature lymphocytes, plasma cells, and occasional mucus-containing fluid, consistent with Warthin’s tumor (papillary cystadenoma lymphomatosum). The architectural pattern shows double-layered oncocytic epithelium with rosette-like clusters and microcystic spaces; however, cytology often lacks intact glandular ducts, making full histology difficult. Clinically, these findings strongly support a benign parotid tumor; the differential includes pleomorphic adenoma and mucoepidermoid carcinoma, particularly if mucous-producing cells or cytologic atypia are present. The diagnostic significance is high when cytology presents characteristic oncocytic cells and a lymphoid stroma; correlation with imaging and clinical features is essential. Management implications include surgical planning for superficial parotidectomy with facial nerve preservation. In cases with cystic change or hemorrhagic background, FNAC may yield background mucus or thick fluid; the presence of numerous oncocytic cells with dense lymphoid stroma is highly suggestive of Warthin’s tumor. Typical demographic associations include older male patients and parotid localization.