Cytology Weekly Cases

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Cytopathology Challenge Weekly Cases
July 21, 2008
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32 year old female. Thin prep pap A) Reactive
endocervical cells B) HSIL C) LSIL D) Squamous
metaplasia E) ASCUS
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• 45 year old female with previous history of a
  thyroid lesion which was resected. She now
  presents with an enlarged lymph node. This is an
  FNA specimen of the lymph node
• Normal lymphoid tissue
• Metastatic squamous cell carcinoma
• Metastatic papillary thyroid carcinoma
• Lymphoma
• Metastatic medullary carcinoma of the thyroid

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4
24 year old female. Thin prep pap A) Squamous
metaplasia B) Negative for intraepithelial
lesion C) HSIL D) ASCUS E) LSIL
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5

• 49 y/o male with corneal ulcer. History of
  getting something in his eye while doing yard
  work. Corneal scrape
• Aspergillus
• Candida
• Mucormucosis
• Fusarium
• Pseudallescheria

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6

• 26 year old female. Thin Prep Pap
• Leptothrix
• Trichomonas
• Candida
• Actinomyces
• No organisms present

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7
65 year old male with hematuria. Bladder
washing A. BK virus effect B. High grade TCC C.
Instrument effect D. Low grade TCC E. Squamous
cell carcinoma
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• 36 year old female. Thin prep pap.
• Squamous metaplasia
• HSIL
• Endocervical cells
• LSIL
• ASCUS

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9

• 50 year old male with neck mass. By examination
  the nodule felt like a lymph node. FNA aspirate
  pap stain
• Positive for tumor
• Atypical
• Reactive
• Normal lymphocytes
• Normal histiocytes

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10

• 55 year old male with LLL mass. Pleural fluid.
• Non-small cell lung carcinoma
• Bronchoalveolar carcinoma
• CMV
• Granulomatous changes
• Benign mesothelial cells

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• 60 year old with pancreatic mass. FNA.
• Reactive
• Positive for tumor
• Send for flow
• Atypical
• Artifact

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Answers

• B HSIL
• Single hyperchromatic atypical cells with high
  NC ratio, irregular nuclear membrane, and clumpy
  chromatin. These single cells are sometimes
  missed on pap smears so beware!
• C Metastatic papillary carcinoma
• Cells are in papillary clusters with grooves and
  an intranuclear inclusion. In a patient with a
  previous history of a thyroid lesion and these
  characteristics, papillary thyroid carcinoma
  should be at the top of your differential.
• E LSIL (Low grade squamous intraepithelial
  lesion)
• Cells with enlarged nuclei (gt 3x that of a normal
  intermediate cell), coarsely granular chromatin
  and koilocytosis ( perinuclear halo).
• D Fusarium
• The corneal scrape just shows septated fungal
  organisms. That is as far as you can go with
  that diagnosis. The slide of the culture shows
  classic banana shaped macroconidia. Fusarium
  is a common cause of keratomycosis. Remember you
  must be able to identify organisms from a fungal
  culture on the boards!!
• B Trichomonas
• Those tricky trich!! There are 4 of them around
  the cell on the left.
• B High grade TCC
• High NC ratio, irregular nuclei, clumpy chromatin
• A Squamous metaplasia
• Squamous metaplastic cells have a cyanophilic
  (blue-green) cytoplasm with a slightly increased
  NC ratio (but always lt50). The nuclear
  contours are smooth and the chromatin is evenly
  distributed. The borders of these cells are
  sharply defined their cytoplasm often looks
  spidery (especially on conventional paps)

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• 8. A Positive for tumor
• Note the pleomorphism, high NC ratio of some
  cells along with the clumpy chromatin. This was
  actually a metastatic melanoma. Melanin pigment
  is present in most of the cells.
• 9. E Benign mesothelial cells
• Mesothelial cells can look like anything!! They
  can often look very ugly when they get reactive.
  These cells have classic features of the ruffled
  skirt (see in the left picture) and the
  mesothelial window seen in the right picture
• 10. B Positive for tumor
• Once again, note the crowding of cells, different
  sizes/shapes of nuclei, irregular nuclear
  membranes. This is most likely a pancreatic
  ductal adenocarcinoma, especially with the mucin
  vacuoles present (though a mucinous
  cystadenocarcinoma cannot be ruled out if this
  was a cystic lesion)