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Cytopathology
Wednesday, March 10, 2004 - 7:30 p.m.
Ballroom B
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Moderator:
CELESTE N. POWERS
Medical College of Virginia
Richmond, VA
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Clinical histories are printed below.
Click on the case numbers for text and references of each case.
Click on each slide thumbnail image for an enlarged view
KIM R. GEISINGER
Wake Forest University School of Medicine
Winston-Salem, NC
A 62 year old man had a mild cough but was otherwise completely asymptomatic and healthy. A routine
chest X-ray demonstrated a small (3 to 4 cm) mass that was centrally located in the lower lobe of the
left lung. Bronchoscopy was performed and described the presence of a "fleshy" tumor. The mass was
brushed and washed. Past medical history was significant for a high grade (Gleason 8) adenocarcinoma
of the prostate which was resected nine years earlier. Although focal capsule penetration was
evident, all lymph nodes were negative.
Case 1 - Figure A - Interlacing capillaries dominate this field which demonstrates a clean smear background. The capillary array is surrounded by individually dispersed small cells and small aggregates of similar cells; these cells are characterized by solitary small dark nuclei and high nuclear-to-cytoplasmic ratios. Similar appearing small cells are attached at various points along the length of the capillaries (Papanicolaou stain, low power).
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Case 1 - Figure B - Scattered small cells possess slightly ovoid nuclei with distinct but delicate membranes, chromatin which is moderately intensely stained, and chromocenters or minute nucleoli. Where visible, cytoplasm is scanty, cyanophilic, and somewhat granular. Distinctly absent are mitotic figures, necrotic debris, and lymphoglandular bodies (Papanicolaou stain, high power).
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Case 1 - Figure C - This cohesive aggregate of small cells demonstrates a high density of nuclei due to high nuclear-to-cytoplasmic ratios. There is a vague suggestion of acinar or rosette formation within the aggregate. Distinctly granular chromatin is present within the small round or ovoid nuclei. Although crowded, true nuclear molding is not apparent (Papanicolaou stain, high power).
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ROBERTO LOGROŅO
University of Texas Medical Branch
Galveston, TX
A 55 year-old man, originally from Haiti, presented to the ENT clinic with a two-month history of an
enlarging left parotid mass. A 3.0 cm firm, tender mass, which appeared to be fixed to skin, was
palpated. There was mild left facial weakness and patient denied weight loss. An FNA was performed.
Case 2 - Figure A - Hypercellular aspirate. Cluster of undifferentiated epithelial cells with scant cytoplasm (Diff-Quik stain, high power).
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Case 2 - Figure B - Aspirate shows clusters of undifferentiated epithelial cells with scant Cytoplasm, finely stippled nuclear chromatin, and vague acinar formation (Papanicolaou stain, high power).
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Case 2 - Figure C - Some epithelial cells are associated with globular hyaline membrane-like material (Papanicolaou stain, high power).
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CHRISTINA KONG
Stanford University School of Medicine
Stanford, CA
An 84-year-old woman is noted to have a 1 cm mass in the right breast on a screening mammogram. The
nodule is palpable and appears as an oval, well-circumscribed solid mass on ultrasound. An FNA biopsy
is performed.
Case 3 - Figure A - Monotonous population of discohesive cells with cytologically bland, round nuclei. At first glance, these cells appear lymphoid but most of the cells in this field are stripped of cytoplasm and represent bare nuclei. Rare intact cells are present in the right-hand half of the photomicrograph. Note the absence of lymphoglandular bodies in the background (Diff-Quik, 200X).
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Case 3 - Figure B - Higher power view shows intact cells with eccentric nuclei and moderate amounts of granular cytoplasm (Diff-Quik, 400X).
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MARY K. SIDAWY
The George Washington University
Washington, DC
A 65-year-old woman referred for FNA of bilateral thyroid nodules which were discovered during a
routine physical examination. A thyroid scan showed bilateral cold nodules. The patient had a
history of systemic lupus erythematosus, and ductal carcinoma in situ of the right breast that was
treated with a mastectomy. Physical examination revealed a firm 1.5 cm left lower pole nodule, and a
softer 2.5 cm nodule in right lobe of the thyroid. Both nodules moved up and down with swallowing.
Aspirate of the right lobe revealed oxyphilic follicular cells and colloid. The FNA of the left
nodule is illustrated.
Case 4 - Figure A - Aspiration of the left lower lobe nodule yielded cohesive large sheet of crowded neoplastic cells. The cells smeared poorly and crush artifact is prominent. Colloid is absent from the background. A polymorphous lymphoid infiltrate is focally appreciated, elsewhere in the smear (Diff-Quik stain, low power).
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Case 4 - Figure B - Higher power image shows neoplastic cells with small, elongated nuclei. Poor preservation due to crush artifact is a prominent finding in this case (Diff-Quik stain, medium power).
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Case 4 - Figure C - High power image shows focal "nested" appearance reminiscent of a microfollicular or acinar arrangement. No mitotic figures or necrosis present (Diff-Quik stain, high power).
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KIM R. GEISINGER
Wake Forest University School of Medicine
Winston-Salem, NC
A 28-year-old man presented with a soft tissue mass in the right supraclavicular region. Clinically,
this was felt to be a hematoma. Radiographically, three was no involvement of bone. A fine needle
aspiration biopsy was performed. Most of the material was submitted for cytologic examination
including cell block with immunocytochemistry; an aliquot was sent to cytogenetics.
Case 5 - Figure A - This smear is moderately to highly cellular and characterized by aggregated and dispersed small homogeneous cells. The smear background is devoid of fibrillary matrix, lymphoglandular bodies, and necrotic material (Diff-Quik stain, low power).
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Case 5 - Figure B - This cohesive cluster manifests no evidence of an organoid arrangement or nuclear molding. The larger cells have small solitary ovoid nuclei with delicate membranes, finely reticulated and evenly dispersed chromatin, absence of nucleoli, and extremely high nuclear-to-cytoplasmic ratios. Where visible, the cytoplasm is faintly basophilic (Diff-Quik stain, high power).
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Case 5 - Figure C - The small cells are strikingly homogenous in appearance. Each possesses a solitary, slightly ovoid nucleus with a delicate membrane, fine, even, dark chromatin, and rare minute nucleoli. Cytoplasm is barely visible (Papanicolaou stain, high power).
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ROBERTO LOGROŅO
University of Texas Medical Branch
Galveston, TX
A 41 year-old male prisoner presented to the ENT clinic with a four-month history of a 3.5 cm left
neck mass, level 4-region, which was firm and non-tender. An FNA was performed.
Case 6 - Figure A - Hypercellular aspirate. Neoplastic cells arranged in an organoid pattern (Papanicolaou stain, low power).
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Case 6 - Figure B - Aspirate shows loosely-cohesive cluster of neoplastic epithelial cells with Moderately abundant cytoplasm, finely granular chromatin, and round to ovoid nuclear shapes(Papanicolaou stain, high power).
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Case 6 - Figure C - Neoplastic epithelial cells in a dispersed-cell pattern. Notice plasmacytoid to spindle cell forms (Papanicolaou stain, high power).
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CHRISTINA KONG
Stanford University School of Medicine
Stanford, CA
A 44-year-old man presents with a 2 cm right inguinal nodule, which has been present for 4-5 years and
is stable in size. Four months prior, he underwent FNA biopsy of a left parotid nodule at an outside
institution; cytology and flow cytometry were consistent with a benign lymph node. An FNA biopsy of
the right inguinal nodule is performed.
Case 7 - Figure A - Cellular smear shows variably sized but predominantly small lymphoid cells that appear cytologically unremarkable. A follicular dendritic cell is present in the field for size comparison (Papanicolaou, 400X).
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Case 7 - Figure B - Predominantly small lymphoid cells with intermixed larger cells and a tingible-body macrophage (Diff-Quik, 400X).
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Case 7 - Figure C - Higher power view of lymphoid cells. Note the presence of occasional clefted and angulated lymphoid cells, as well as numerous lymphoglandular bodies in the background (Diff-Quik, 600X).
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MARY K. SIDAWY
The George Washington University
Washington, DC
A 49-year-old woman presents with abdominal pain and a distal pancreatic mass. She has a history of
pancreatitis and a pseudocyst 19 years ago. Smears were evaluated during intraoperative consultation.
Case 8 - Figure A - Hypercellular smear containing single and loosely cohesive small neoplastic cells. Stripped nuclei are prominent. Hyaline globules and metachromatic stroma are seen within a "rosette" and in the background (Diff-Quik stain, medium power).
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Case 8 - Figure B - Hypercellular smear containing single and loosely cohesive small neoplastic cells. The nuclei are round to oval with no significant atypia. The cytoplasm is delicate and indistinct (H&E, medium power).
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Case 8 - Figure C - At high magnification the nuclei show nuclear membrane irregularity and prominent nuclear grooves. Small, distinct nucleoli are noted (H&E stain, high power).
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