The Role of Fine‑Needle Aspiration Biopsy in Diagnosing Pediatric Malignant Small Round Cell Tumors: Lessons from a Resource‑Limited Setting
Tiffany Wongsodiharjo1,2*, Nila Kurniasari1,2, Etty Hary Kusumastuti1,2
Abstract
Background: Malignant small round cell tumors (MSRCTs) in children are a heterogeneous group of neoplasms with overlapping cytomorphologic features, creating diagnostic challenges. Fine‑needle aspiration biopsy (FNAB) is widely used in resource‑limited settings as a minimally invasive diagnostic tool, but its accuracy in differentiating MSRCT subtypes remains debated. Method: This retrospective descriptive study reviewed pediatric MSRCT cases at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from January 2020 to December 2024. Twenty‑four patients aged 0–18 years with complete FNAB, histopathology, and immunohistochemistry data were included. Cytological features, background findings, and cytomorphologic patterns were compared with postoperative histopathology to assess diagnostic concordance. Result: Neurogenic tumors were the most frequent (41.7%), with Ewing’s sarcoma as the predominant subtype (25%). The diffuse round cell pattern was the most common cytomorphologic finding (45.8%), followed by rosette formation (16.7%) and alveolar/pseudoalveolar patterns (8.3%). Distinctive features such as rosettes in neuroblastoma and retinoblastoma or alveolar arrangements in rhabdomyosarcoma enhanced diagnostic specificity, whereas diffuse patterns were less discriminative. FNAB showed good concordance with histopathology in nuclear morphology, cellularity, and growth patterns. Ewing’s sarcoma consistently demonstrated small‑to‑medium nuclei with hypercellularity and diffuse arrangements, while osteosarcoma exhibited clustered patterns with hypocellularity. Discussion: FNAB provides valuable cytological insights into pediatric MSRCTs and demonstrates strong concordance with histopathology. However, nonspecific diffuse patterns limit its standalone diagnostic value. Integration with immunohistochemistry, particularly CD99 and FLI1 for Ewing’s sarcoma, and molecular testing, where available, is essential to achieve diagnostic precision and guide timely therapeutic decisions.
Keywords
fine‑needle aspiration biopsy; pediatric oncology; malignant small round cell tumor; cytomorphology; histopathology correlation.
Cite This Article
Wongsodiharjo, T., Kurniasari, N., Kusumastuti, E. H. (2025). The Role of Fine‑Needle Aspiration Biopsy in Diagnosing Pediatric Malignant Small Round Cell Tumors: Lessons from a Resource‑Limited Setting. International Journal of Scientific Advances (IJSCIA), Volume 6| Issue 5: Sep – Oct 2025, Pages 979-987 URL: https://www.ijscia.com/wp-content/uploads/2025/10/Volume6-Issue5-Sep-Oct-No.961-979-987.pdf
Volume 6 | Issue 5: Sep – Oct 2025
