Cytology Weekly Cases

1
Cytopathology Challenge! Weekly Cases
Week of Nov 5th 2007
2

• 51 year-old male with lung
• transplant. BAL.
• Reactive
• CMV
• Bronchioloaveolar carcinoma
• TB granulomatous changes
• Non-small cell lung carcinoma

1
3

• 67 year old female with
• pulmonary infiltrate. BAL.
• Squamous cell carcinoma
• Small cell carcinoma
• Adenocarcinoma
• Bronchioloalveolar carcinoma
• Reactive

2
4

• 34 year old female. ThinPrep pap
• Endocervical cells
• Squamous metaplasia
• ASCUS
• LSIL
• HSIL

3
5

• 58 year-old male with lung mass.
• FNA cell block.
• Squamous metaplasia
• Non-small cell lung carcinoma
• Small cell carcinoma
• Large cell variant neuroendocrine carcinoma
• Granuloma

4
6

• 44 year old female with cold
• thyroid nodule. FNA demonstrated scant
• colloid and sheets of these cells in
• microfollicular pattern.
• Follicular adenoma
• Follicular carcinoma
• Indeterminate
• Papillary carcinoma
• Medullary carcinoma

5
7

• 34 year old female. ThinPrep pap
• Endocervical cells
• Squamous metaplasia
• ASCUS
• LSIL
• HSIL

6
8

• 59 year old female with breast
• cancer and pleural effusion.
• Pleural fluid cytospin.
• Metastatic breast carcinoma
• Reactive pulmonary macrophages
• Reactive mesothelial cells
• Viral inclusion
• Mesothelioma

7
9

• 29 year old female. ThinPrep pap
• Endometrial cells
• Endocervical cells
• ASC-US
• LSIL
• HSIL

8
10
49 year old female with thyroid nodule. FNA
DiffQuik A. Goiter B. Graves disease C. Cyst
contents D. Neoplasm E. Hurthle cells/reactive
9
11

• 67 year old male. Bladder wash.
• Reactive urothelial/umbrella cell
• Papillary neoplasm low grade
• Papillary neoplasm high grade
• Squamous cell carcinoma
• HPV effect

10
12
Answers

• A Reactive
• Multi-nucleated bronchial epithelial cell.
  Sometimes they do thatnot related to tumor or
  specific virus
• E Reactive endobronchial cells and macrophages
• Open chromatin, reactive nucleoli. No tumor in
  this.
• E HSIL
• High NC ratio, irregular nuclei
• B Non-small cell lung CA
• Probably squamous. Too much cytoplasm for
  neuroendocrine or small cell. NC ratio and
  hyperchromatic nuclei would argue against
  granuloma
• C Indeterminate
• The scant colloid and sheets or follicular cells
  (photo) in a microfollicular pattern would
  suggest a follicular lesion, but we cant assess
  adenoma vs carcinoma on FNA so we call them
  indeterminate.
• D LSIL
• Koilocytes again!
• A Metastatic breast CA
• Mucin in the cytoplasm almost forming a signet
  ring.
• B Reactive endocervical cells
• Normal. No dysplasia in this one.
• D. Neoplasm Papillary thyroid carcinoma
• See the nuclear pseudoinclusion.
• A Reactive urothelium/umbrella cell