—  SPECIALTY CONFERENCE HANDOUT  — Cytopathology Wednesday, March 21 , 2012, 7:30 PM Convention Centre 301-305 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 Moderator: PAUL WAKELY The Ohio State Univ/Medicine Columbus, OH Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: Lester J. Layfield, University of Utah, Salt Lake City, UT Jan F. Silverman, West Penn Allegheny Gen Hosp, Pittsburgh, PA Dina R. Mody, The Methodist Hospital, Houston, TX David Chhieng, Yale University School of Medicine, New Haven, CT Clinical histories are displayed below. For the fastest viewing of virtual slides, click: under each thumbnail image below. You must have Aperio ImageScope installed on your PC. If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP Virtual Slides. Click the icon on the right to get your free copy:   Or, click on slide thumbnail images to view each slide in a Web-based slide viewer, which is somewhat slower. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 - Click here for Text and References Submitted by: Lester Layfield - University of Utah, Salt Lake City, UT Clinical Summary: The patient is a 43 year old Iraqi American with a history of hypertension and hemophilia with Factor VIII deficiency. He has received numerous blood transfusions to help control his hemophilia. The patient is HIV positive secondary to multiple blood transfusions and also is known to be Hepatitis C positive. In May of 2009, the patient presented to Orthopedic Oncology Clinic with a large (20 cm) right thigh and hip mass. The mass was initially believed to be a massive hematoma based on his known history of hemophilia. Imaging studies including CT and MRI were equivocal for a neoplasm and a fine-needle aspiration was obtained. The FNA revealed rare atypical cells admixed with a large amount of blood. The patient underwent drainage and debulking of the suspected hematoma. Histologic evaluation of the specimen resulted in a diagnosis of malignancy. Following this diagnosis, the mass was resected. The patient was placed on chemotherapy and followed with CT examinations of the leg to detect possible recurrence as well as chest x-rays every three months. In October of 2011, multiple pulmonary nodules were detected as was an adrenal mass. Fine-needle aspiration of the adrenal mass was performed which yielded the material submitted for review. Case 1 - Figure 1 Smear preparation showing a hypercellular area with many single cells and occasional small cell clusters. (Diff-Quik, x 200) Case 1 - Figure 2 Single non-cohesive tumor cells with a polygonal shape. The nuclei are large and irregular. A single non-symmetrical mitotic figure is present. (Diff-Quik, x 200) Case 1 - Figure 3 The individual neoplastic cells have moderate to abundant amounts of cytoplasm. The nuclei are eccentrically located and hyperchromatic often with large nucleoli. (Diff-Quik, x 400) Case 1 - Figure 4 Cell block with tissue fragment composed of fibrous tissue surrounding groups of large epithelioid cells with abundant cytoplasm. (H&E, x 200) Case 1 - Figure 5 Smear preparation containing a small cluster of tumor cells surrounding a clear lumen. (Diff-Quik, x 400) Case 1 - Figure 6 Cell clusters composed of epithelioid and spindle-shaped cells. Many cells have a vacuolated cytoplasm. (Diff-Quik, x 600) Case 1 - Figure 7 Oval to polygonal cells with large nuclei containing prominent nucleoli. Nuclei often have nuclear membrane irregularities. (Diff-Quik, x 1000) Case 1 - Figure 8 Smear preparation containing occasional cells with atypical mitotic figures. (Diff-Quik, x 400) Case 1 - Figure 9 Large tumor cells with multilobulated nuclear and large intracytoplasmic vacuoles. (Diff-Quik, x 1000) Case 1 - Figure 10 Large mononuclear and binucleate tumor cells with abundant cytoplasm. (Diff-Quik, x 1000) Case 1 - Figure 11 Large epithelioid cells some of which have vacuoles. The nuclei are often eccentrically located and have prominent nucleoli. (Diff-Quik, x 1000) Case 1 - Figure 12 Multinucleated tumor giant cell. (Diff-Quik, x 1000) Case 2 - Click here for Text and References Submitted by: Jan Silverman - West Penn Allegheny Gen Hosp, Pittsburgh, PA Clinical Summary: 80 y/o African-American male with history of CLL/SLL underwent FNA new 8 cm. left inguinal mass Case 2 - Figure 1 DQ10x Case 2 - Figure 2 DQ10x-2 Case 2 - Figure 3 DQ20x-1 Case 2 - Figure 4 DQ20x-2 Case 2 - Figure 5 DQ40x Case 2 - Figure 6 PAP10x Case 2 - Figure 7 PAP20x-1 Case 2 - Figure 8 PAP20x-2 Case 2 - Figure 9 PAP40x-2 Case 3 - Click here for Text and References Submitted by: Dina R. Mody - The Methodist Hospital, Houston, TX Clinical Summary: 39 YR old hispanic male who was working in his garage and suddenly developed hemoptysis. Rushed to local emergency room. Found to have a "patch" of pneumonia on chest films. Was transfered to tertiary care center due to deterioration of condition. Pertinent Laboratory Data: Patient admitted to ICU. Condition worsening. BAL (Bronchioloalveolar lavage) performed. HIV status is unknown at time of reciept of BAL in laboratory but was subsequently found to be negative Case 3 - Figure 1 Case 3 - Figure 2 Case 3 - Figure 3 Case 3 - Figure 4 Case 3 - Figure 5 GMS Case 3 - Figure 6 GMS Case 3 - Figure 7 Gram Case 4 - Click here for Text and References Submitted by: David Chhieng - Yale University School of Medicine, New Haven, CT Clinical Summary: A 66 year old man was found to have an incidental thyroid nodule on ultrasound examination. He had no other symptoms. He had history of head and neck irradiation exposure in childhood. There was no other significant medical or surgical history or pertinent family history except for a left facial hemanigoma. On physical examination, a small nodule was palpable in the isthmus of the thyroid gland. The patient had no palpable lymphadenopathy. Thyroid function tests were within normal limits. Thyroid ultrasound revealed a well-circumscribed hypoechoic nodule, measuring 1.5 cm, in the right isthmus. There were also several smaller nodules scattered in both the left and right lobes of the thyroid gland. The patient underwent an ultrasound guided fine needle aspiration biopsy of the isthmic nodule. Case 4 - Figure 1 Low power magnification showing a paucicellular aspirate with several cohesive cellular groups. (Papanicolaou stain, X20) Case 4 - Figure 2 Neoplastic cells in groups and single cells in a myxoid background. (Papnicolaou stain, X100) Case 4 - Figure 3 Magenta stromal fragments with irregular borders. (Diff Quik stain, X400) Case 4 - Figure 4 Individual cells demonstrate round to oval nuclei and moderate amount of cytoplasm which blend with the extracellular materials. The latter appears bluish grey. (Papanicolaou stain, X400) Case 4 - Figure 5 Plasmacytoid cells and scattered spindle cells appear singly in a fibrillary myxoid background. (Papnicolaou stain, X400) Case 4 - Figure 6 Individual cells demonstrate mild nuclear enlargement and fine chromatin. Nuclear pleomorphism is minimal. (Papanicolaou stain, X400) Case 4 - Figure 7 Plasmacytoid cells embedded in a fibrillay myxoid background. (Papanicolaou stain, X400) Case 4 - Figure 8 A cohesive group of bland appearing epithelial cells and stromal fragment which stains magenta. (Diff Quik stain, X200) Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting.