Diagnostic problems of second primary malignancies detected by fine-needle aspiration cytology

The diagnosis of second malignant tumors, the incidence of which is increased because of the increased duration of survival for many tumor types in patients treated for cancer, represents one of the most important aspects of application of fine-needle aspiration (FNA).

Forty patients who had been treated for a malignant tumor and who developed a second primary tumor detected by FNA and subsequently confirmed by histologic examination were studied. The primary tumors were malignant lymphoma (15 cases); breast carcinoma (10 cases); cutaneous melanoma (3 cases); carcinoma of the larynx and of the uterine cervix (2 cases each); and dysgerminoma of the ovary, chronic myeloid leukemia, and carcinoma of the nose, floor of the mouth, tonsil, anus, kidney, and skin (one case each). The interval between the diagnosis of the first and second malignant tumors ranged from 1 month to 22 years.

Carcinoma of the lung, mainly represented by adenocarcinoma, was the most frequent second malignant tumor that occurred in this series (15 cases). It was followed by carcinoma of the breast (5 cases); soft tissue sarcoma (3 cases); and carcinoma of the liver, kidneys, ovaries, thyroid gland (2 cases each), parotid gland, and skin. Five cases of non-Hodgkin lymphoma and one of Hodgkin disease developed in patients with a previous carcinoma at various sites. Four non-Hodgkin lymphomas occurred as the second primary malignant tumor in patients treated with radiation therapy for a mammary carcinoma. One case of multiple myeloma occurred.

The accuracy of FNA in diagnosing second primary tumors (100%) and in classifying them by histologic type (62.5%) was demonstrated.