Review ArticlesApproach to Mediastinal Fine Needle Aspiration CytologyLi, Zaibo MD, PhD*; Xu, Huihong MD†; Fan, Fang MD, PhD‡ Author Information *Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH †Department of Pathology, Boston VA Healthcare System, Boston University, Boston, MA ‡Department of Pathology, City of Hope Medical Center, Duarte, CA The authors have no funding or conflicts of interest to disclose. Reprints: Zaibo Li, MD, PhD, Department of Pathology, The Ohio State University; 410 W. 10th Ave, Columbus, OH 43210 (e-mail: [email protected]) All figures can be viewed online in color at www.anatomicpathology.com. Advances In Anatomic Pathology 29(6):p 337-348, November 2022. | DOI: 10.1097/PAP.0000000000000355 Buy Metrics Abstract Mediastinal fine needle aspirations are routinely encountered in cytopathology practice. Mediastinal lesions may pose diagnostic challenges owing to their rarity and locations associated with the complexity of the mediastinal anatomic structures in the thoracic cavity. Diagnosing mediastinal lesions and guiding patient management usually require correlating with clinical and radiologic findings, being familiar with cytomorphologic features and appropriately triaging the diagnostic material for ancillary testing. This review proposes a practical approach to interpret mediastinal fine needle aspirations and emphasizes potential diagnostic pitfalls for mediastinal lesions including benign cysts, thymic neoplasms, lymphoproliferative disorders, germ cell tumors, mesenchymal tumors, and metastatic tumors. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.