|
Cytopathology
Sunday, February 12, 2006 - 7:30 PM
Regency VI
|
Moderator:
Mary K. Sidawy
George Washington University
Washington, DC
Disclosure: The speakers have indicated they have nothing to disclose.
|
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
Submitted by:
Gregg A. Staerkel
University of Texas
M.D. Anderson Cancer Center, Houston, TX
44 year-old woman noted progressive left-sided otalgia from a 3.5 cm parotid gland mass. Palpation disclosed a firm, hypomobile, tender left postauricular mass with ill-defined margins. Fine needle aspiration was performed.
Case 1 - Figure 1 -
Smear shows a moderately cellular aspirate with largely cohesive, basaloid cell groups. Nuclei are round to oval with evenly dispersed chromatin and hyperchromasia. The lower right side of the cell group illustrated shows intercellular hyaline-like material that is both globular and linear in nature. Mitotic activity and necrosis are not identified. (Diff-Quik, medium power)
|
Case 1 - Figure 2 -
Two distinct cell group patterns are seen: tubular and solid sheet. Nuclei seen within the tubular fragment are much tighter packed and more basaloid in appearance than most cells seen within the fragment displaying a solid growth. (Papanicolaou, low power)
|
Case 1 - Figure 3 -
Focally, squamoid appearing cells are seen. These cells are identified by their larger, paler elongated nuclei and greater amounts of cytoplasm, as measured by the separation between nuclei. (Papanicolaou, medium power)
|
Case 1 - Figure 4 -
This basaloid cell fragment shows a slight tendency for nuclei to palisade, particularly at the cell group's edge. (Papanicolaou, medium power)
|
Case 1 - Figure 5 -
Focal areas of abundant hyaline-like material are seen in a vaguely globular pattern, which is delineated by small, round, basaloid cells. (Papanicolaou, low power) Cytologic Diagnosis: Basal cell neoplasm, favoring basal cell adenocarcinoma Histologic Diagnosis: Basal cell adenocarcinoma
|
Case 1 - Figure 6 -
Histologic section showing small and large nests of basaloid cells. Centrally some cells are larger and pale with a little more visible cytoplasm. These cells blend with the surrounding more basaloid cells. A degree of nuclear pallisading is seen at the edges of some of the basaloid cell nests. (H & E, low power)
|
Case 1 - Figure 7 -
Tumor cells are seen adjacent to nerve branches. In addition, a small focus of squamoid differentiation is present. (H & E, low power)
|
Submitted by:
Barbara A. Crothers
Walter Reed Army Medical Center
Washington, DC
A 33 year old woman presented for follow-up Pap test four months following definitive treatment for invasive adenocarcinoma of the cervix arising from endocervical adenocarcinoma in-situ. The tumor was stage T1b N0 MX. The clinical history on the Pap test indicated a "history of cervical cancer" and was submitted as a cervicovaginal Thin Prep specimen.
Case 2 - Figure 1 -
Low power appearance of Pap test with scant cellularity, few squamous cells, occasional glandular groups and abundant background debris consisting of lysed blood and neutrophils. Thin Prep® Pap test, Papanicolaou stain, 20X.
|
Case 2 - Figure 2 -
Menstrual- type endometrial glandular cells with admixed neutrophils and bloody debris. The cells have uniform nuclear and nucleolar sizes and moderate cytoplasm. Thin Prep® Pap test, Papanicolaou stain, 60X.
|
Case 2 - Figure 3 -
Reparative columnar cells, likely from the endocervical-endometrial junction. Despite some irregularity of the nuclear membranes, they are smooth, the chromatin is finely granular and evenly distributed, nucleoli are small and the cells have abundant cytoplasm. Thin Prep® Pap test, Papanicolaou stain, 100X.
|
Case 2 - Figure 4 -
Reparative columnar cells. Notice the distinct cytoplasmic boundaries between the cells. Nucleoli, while large, are smooth and round. The enlarged cell has abundant cytoplasm. Thin Prep® Pap test, Papanicolaou stain, 100X.
|
Case 2 - Figure 5 -
Reparative columnar cells. This group shows the "taffy pull" effect of repair. Nuclei are smooth with even chromatin, despite multiple prominent nucleoli. There are two squamous cells in the upper left; one is parakeratotic. Thin Prep® Pap test, Papanicolaou stain, 40X.
|
Submitted by:
Richard M. DeMay
University of Chicago
Chicago, IL
Fine needle aspiration biopsy of soft tissue mass in the forearm.
Submitted by:
Eva M. Wojcik
Loyola University Medical Center
Maywood, IL
A 54 year old female with history of cervical squamous cell carcinoma diagnosed 15 years earlier for which she underwent a total abdominal hysterectomy followed by radiation therapy was referred to the gynecology – oncology clinic for the evaluation of a pelvic (perirectal) mass. Pap Test (Thin PrepTM) of a vaginal cuff was obtained.
Case 4 - Figure 1 -
Thin Prep™ Papanicolaou stain, high power: This image shows a loose tri-dimensional cluster of spindle cells with a delicate, vacuolated cytoplasm, relatively uniform oval nuclei with irregular nuclear membrane. The chromatin is irregular and occasional nuclear grooves are present.
|
Case 4 - Figure 2 -
Thin Prep™ Papanicolaou stain, high power: Throughout the specimen there were single, pleomorphic malignant cells. This image shows a large bi-nucleated cell with rather abundant delicate cytoplasm, nuclei with coarse chromatin and prominent nucleoli. In addition, two naked, similar nuclei are present.
|
Case 4 - Figure 3 -
Thin Prep™ Papanicolaou stain, high power: The background is necrotic and appreciated as granular amorphous debris and fragments of red blood cells attached to cells ("clinging diathesis"). In addition, mitotic figures are seen.
|
Case 4 - Figure 4 -
Thin Prep™ Papanicolaou stain, high power: Many cells are elongated or spindled. This image presents a cell with eccentrically located nucleus with irregular nuclear membrane, coarse chromatin and prominent nucleolus. The cytoplasm is abundant and contains large vacuoles.
|
Case 4 - Figure 5 -
Thin Prep™ Papanicolaou stain, high power: Occasional cells contain other cells, cellular debris or fragments of red blood cells within large cytoplasmic vacuoles. This image demonstrates one of these cells. Necrotic background is appreciated.
|
Submitted by:
Gregg A. Staerkel
University of Texas
M.D. Anderson Cancer Center, Houston, TX
57-year-old man with back and neck discomfort had a chest CT which disclosed a 2 cm anterior chest wall mass and multiple low density lesions within the liver. A liver aspiration was performed.
Case 5 - Figure 1 -
Smears show cohesive (right side) to loosely cohesive (left side) epithelioid cell groups. Mild to focally moderate atypia, hallmarked by nuclear irregularity and intranuclear inclusions, is seen. Nuclei have a tendency to be polarized to one end of the cell. (Papanicolaou, medium power)
|
Case 5 - Figure 2 -
Tumor cells (left side) are seen in contrast to normal hepatocytes (right side). The abnormal cells show a greater degree of nuclear enlargement. Because of eccentric nuclear placement, a "hobnail" appearance is created. Occasional single cells demonstrate stretched cytoplasm (top center) and an inconspicuous cytoplasmic vacuole is present (arrow). (Papanicolaou, high power)
|
Case 5 - Figure 3 -
This loosely cohesive tumor cell group shows two prominent intranuclear cytoplasmic inclusions and vaguely apparent cytoplasmic clearing/vacuolization (arrow). Nuclei within these latter cells are particularly eccentric. (Papanicolaou, medium power)
|
Case 5 - Figure 4 -
Tumor cells show a greater degree of nuclear size variation and irregularity. A more defined cytoplasmic vacuole can be identified (arrow). (Papanicolaou, high power) Cytologic Diagnosis: Neoplastic cells consistent with epithelioid hemangioendothelioma Histologic Diagnosis: Epithelioid hemangioendothelioma
|
Case 5 - Figure 5 -
Histologic section shows abundant infiltrating tumor cells in a collagenous matrix. Prominent cytoplasmic vacuoles are noted. ( H & E, low power)
|
Case 5 - Figure 6 -
Cytoplasmic vacuoles, representing intracellular vascular lumina, of various sizes are present. Nuclei are eccentrically placed and demonstrate variable degrees of nuclear size and irregularity. Neoplastic cells range from "epithelioid" to "dendritic" in nature. (H & E, high power)
|
Submitted by:
Barbara A. Crothers
Walter Reed Army Medical Center
Washington, DC
A 50 year old woman presented to the GYN clinic with a history of recent vaginal spotting over four months. Her cervical Pap test requisition stated that she was not postmenopausal, had not had a hysterectomy, was on birth control pills and had a normal Pap test one year ago. The physician also noted that she had a cervical polyp on examination and recent abnormal endometrial bleeding.
Case 6 - Figure 1 -
The slide contains scattered normal squamous cells and a sheet of endocervical repair but also a single smooth muscle cell with irregular, wispy cytoplasm. Thin Prep® Pap test, Papanicolaou stain, 40X.
|
Case 6 - Figure 2 -
The two smooth muscle cells at the top of the image have nuclei at least 4X the area of the normal metaplastic cells in the image. Thin Prep® Pap test, Papanicolaou stain, 60X.
|
Case 6 - Figure 3 -
The nuclei of the smooth muscle cells have smooth nuclear membranes, fine to moderately granular chromatin, multiple nucleoli and chromocenters. The cytoplasm is characteristically granular, ill-defined and fades into the background. Thin Prep® Pap test, Papanicolaou stain, 60X.
|
Case 6 - Figure 4 -
Two normal squamous cells abut a collection of leiomyoma cells with inconspicuous cytoplasmic borders. The leiomyoma nuclei are variable in size with folds and areas of chromatin condensation. Thin Prep® Pap test, Papanicolaou stain, 60X.
|
Case 6 - Figure 5 -
Reactive endocervical cells from the polyp. The nuclei are round, uniform in size and have inconspicuous nucleoli. The cytoplasm of the cell at the top of the image contains neutrophils, a common finding in cervical/endocervical polyps. Thin Prep® Pap test, Papanicolaou stain, 60X.
|
Submitted by:
Richard M. DeMay
University of Chicago
Chicago, IL
- Fine needle aspiration biopsy
- 45 year old male
- 1 cm tonsillar/parapharyngeal mass
Submitted by:
Eva M. Wojcik
Loyola University Medical Center
Maywood, IL
A 64 year old man, as part of his work-up for microhematuria, was found to have a large, partially cystic right kidney mass. CT-guided FNA of the renal lesion was performed.
Case 8 - Figure 1 -
Aspirate shows a two-dimensional cluster of large cells with abundant granular cytoplasm, ovoid nuclei with fine chromatin and small distinct nucleoli. (Papanicolaou stain, high power).
|
Case 8 - Figure 2 -
A papillary-like cluster of cells with high nuclear/ cytoplasmic ratio and varying in size round to oval nuclei. The chromatin is fine and small nucleoli can be appreciated. (Diff- Quik stain, high power)
|
Case 8 - Figure 3 -
A loose cluster of cells with abundant delicate granular cytoplasm and oval nuclei. Some of the nuclei appear indented. (Diff-Quik stain, high power).
|
Case 8 - Figure 4 -
A loose sheath of degenerated/necrotic large cells with abundant cytoplasm admixed with inflammatory cells. (Diff- Quik stain, high power).
|
|
|
|
|
