Multisystem Cytology Unknowns

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Multi-system Cytology Unknowns

• Thursday, May 23, 2006
• John Webster, MD

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Case 1

• 57 yo WM
• Mass, mid-distal esophagus, celiac
  lymphadenopathy, hepatic mass
• Endoscopic FNA, celiac lymph node

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Cytologic Diagnosis

• Malignant cells with necrosis, favor poorly
  differentiated carcinoma (IHC pending)
• IHC TTF-1, CK20, and CDX2 negative
  synaptophysin, chromogranin, CK7 positive
  consistent with neuroendocrine carcinoma

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Histology Diagnosis

• Neuroendocrine carcinoma (IHC LCA negative
  chromogranin, synaptophysin, and keratin positive

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Case 2

• 69 yo WF
• Postmeopausal, hysterectomy, HRT, Premarin
• Vaginal Thin-Prep

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Cytology Diagnosis

• HSIL

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Histology Diagnosis

• Moderate to severe dysplasia (CIN II-III).

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Case 3

• 57 yo WF
• Hx BRCA in 1999, now with mixed lytic and
  sclerotic lesion of left T5 vertebra
• FNA, T5 vertebra

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Cytology Diagnosis

• Consistent with metastatic breast carcinoma

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Histology Diagnosis

• Metastatic carcinoma consistent with breast
  primary (IHC GCDFP negative ER, PR positive)

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Case 4

• 68 yo WM
• Rectal carcinoma, now with sacral lytic lesion
• FNA, Sacral mass

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Cytology Diagnosis

• Metastatic carcinoma with abundant mucin

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Histology Diagnosis

• Metastatic adenocarcinoma with mucin consistent
  with rectal carcinoma

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Case 5

• 73 yo BF
• Left metastatic lymph node adenocarcinoma of
  unknown primary
• FNA, lymph node, left

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Cytology Diagnosis

• Adenocarcinoma (TTF-1, CK20, GCDFP negative CK7,
  CA125 positive)

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Histology Diagnosis

• Metastatic adenocarcinoma with papillary
  architecture and psammoma bodies of probable
  ovarian origin (IHC TTF-1, GCDFP negative CK7
  positive