Case 1 - Click here for Text and References
Submitted by: Susan J. Maygarden
Clinical Summary:
A 21 year old college student presented with jaw pain, fullness under the left angle of the jaw, diminished hearing in the left ear, trismus and 15 pound weight loss. This initially was felt to represent unilateral otitis media, but when myringotomy was unsuccessful an MRI scan was obtained, which showed a large parapharyngeal mass displacing the left tonsil medially and extending to the skull base. Transoral fine needle aspiration was performed. The images are from Diff-Quik and Pap stained direct smears and H&E stained cell block from the aspiration.
20x - Aggregates and dispersed spindled and epitheloid cells.
60x DiffQuik - Crowded aggregate of epitheloid cells.
20x Pap - Small aggregates of short spindled and epitheloid cells.
60x Pap - Higher power of figure 3 of short spindled cells with smooth chromatin and few apoptotic cells.
20x cell block - Aggregates of eosinophilic, epitheloid cells that have an almost squamoid appearance. Eosinophilic acellular material is present in the lower right hand aspect of the image.
60x cell block - Aggregate of spindled cells having a granulomatous appearance.
60x cell block - Aggregate of spindled cells.
60x cell block - Higher power of the epitheloid area in figure 5 with apoptosis.
core biopsy 20x - Core biopsy showing malignant small spindled cells in an eosinophilic matrix.
core biopsy 60x - High power of the core biopsy demonstrating the abundant matrix material.
Case 2 - Click here for Text and References
Submitted by: Diane D. Davey
Clinical Summary:
A 69 year old man with a history of non-small cell lung carcinoma 8 years prior presents with a 2 month history of worsening shortness of breath, fatigue, weight loss, cough, and wheezing. He had been treated with both chemotherapy and radiation and continued to smoke 1/2 pack per day. A work-up revealed a large pleural effusion, plus intense right lung and pleural uptake on a PET scan. A pleural effusion was submitted to cytology for evaluation.
Pertinent Laboratory Data:
Pleural fluid WBC: 1069/µL; pleural fluid RBC: 3700/µL; pleural fluid protein: 4.6 g/dL Complete blood count showed Hematocrit 42%, WBC 14,000/µL, platelets 179,000/µL
Pap 1 - Pleural fluid showing predominantly lymphoid cells with few mesothelial cells and histiocytes. Lymphocytes are mostly small to medium. There is artifactual clustering of cells.
Pap 2 - Pleural fluid showing predominantly lymphoid cells with few mesothelial cells and histiocytes. Lymphocytes vary in size and some show nuclear clefts and nucleoli.
Pap 3 - High power of pleural fluid ThinPrep. Lymphoid cells vary in size and there is pronounced nuclear irregularity including few with marked convolutions (upper left).
Pap 4 - High power of pleural fluid ThinPrep. Lymphoid cells vary in size and there is pronounced nuclear irregularity including few with marked convolutions.
CB low power - Cell block showing lymphocytosis.
CB high - Lymphocytosis with variation in size of cells, nuclear clefts and convolutions, and some nucleoli.
SS cytokeratin - demonstrates rare cells and clusters consistent with mesothelial cells seen on Pap stain.
SS Leukocyte common Ag - Most cells are positive consistent with lymphoid origin.
Blood smear: Blood smear shows one neutrophil and three lymphoma cells with clefted nuclei and scant cytoplasm.
Pleural biopsy: dense lymphoid infiltrate within connective tissue representing mantle cell lymphoma as proven by Cyclin D1 and other immunostains.
Case 3 - Click here for Text and References
Submitted by: Tarik Elsheikh
Clinical Summary:
59 year old man presented with a tumor of the left parotid gland, which has been growing in size. The tumor was noted to be in the deep lobe of parotid.
An ultrasound-guided FNA was performed. A single LBC (ThinPrep) slide was prepared.
Case 4 - Click here for Text and References
Submitted by: Zubair W. Baloch
Clinical Summary:
24-year-old woman presented with a large neck mass involving thyroid and right lateral neck. According to the patient this mass originally started as a small nodule and has rapidly increased to the present size of 4.5 cm over the course of 6 months. She had a thyroid ultrasound which demonstrated right thyroid mass associated with right cervical adenopathy; indirect laryngoscopy showed extrinsic compression of trachea from right anterior aspect. Patient underwent CT neck, which showed a 4.5 cm mass centered on the right lobe of the thyroid gland, narrowing and displacing the trachea. Patient also had a PET/CT which showed an intensely FDG avid mass centered on the right lobe of the thyroid, narrowing and displacing the trachea with multiple FDG avid right cervical lymph nodes extending into the thoracic inlet.
Diff-Quik stained air-dried smear showing pleomorphic lesional cells arranged in loosely cohesive groups.
Diff-Quik stained air-dried smear showing pleomorphic lesional cells round to oval in shape arranged in cohesive flat sheet with smooth border.
Papanicolaou stained smear demonstrating lesional cells associated with stromal material.
Tumor cells associated with transgressing blood vessels.
Round to spindle shaped tumor cells with even chromatin and scant cytoplasm.
Round to spindle shaped tumor cells with nuclear overlapping and crowding, mild to moderate nuclear molding arranged in cohesive group. This cell group also demonstrates single cell necrosis.
Cell block demonstrating a fragment of columnar appearing epithelium and round to spindle shaped tumor cells with single cell necrosis.
Low power showing a tumor replacing most of the thyroid
Medium power demonstrating tumor consisting of primitive elements
High power showing blastema like stroma, mature squamous or glandular epithelial elements
Cartilage in the blastema like stroma