Endoscopic Ultrasound–Guided Fine-Needle Aspiration: Sampling, Pitfalls, and Quality Management  Peter Kulesza, Isam A. Eltoum  Clinical Gastroenterology and Hepatology  Volume 5, Issue 11, Pages 1248-1254 (November 2007) DOI: 10.1016/j.cgh.2007.09.011 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 Squamous cell carcinoma. The single squamous cell has organgephyllic keratin, but lacks other malignant features. The cells in the epithelial cluster above it show nuclear enlargement, abnormal chromatin condensation and prominent nucleoli, and nuclear border irregularity (PAP, 400×). Color version of this figure available at www.cghjournal.org. Clinical Gastroenterology and Hepatology 2007 5, 1248-1254DOI: (10.1016/j.cgh.2007.09.011) Copyright © 2007 AGA Institute Terms and Conditions

Figure 2 (A) Benign macrophages in mediastinal lymph node smear. The cells are large, with kidney bean-shaped nuclei, and numerous pigment granules in the cytoplasm. There is a background of small lymphocytes (DiffQuik, 400×). (B) Malignant melanoma. The malignant cells have plasmacytoid morphology, round nuclei with prominent nucleoli, and very delicate cytoplasmic granularity. There is no evidence of melanin pigment (DiffQuik, 400×). Color version of this figure available at www.cghjournal.org. Clinical Gastroenterology and Hepatology 2007 5, 1248-1254DOI: (10.1016/j.cgh.2007.09.011) Copyright © 2007 AGA Institute Terms and Conditions

Figure 3 (A) Gastric wall smooth muscle. There are numerous elongated nuclei within dense, strongly staining matrix (DiffQuik, 400×). (B) Schwannoma: there is a vague pallisading arrangement of the nuclei (DiffQuik, 400×). (C) GIST. The smear is uniformly cellular (DiffQuik, 100×). Clinical Gastroenterology and Hepatology 2007 5, 1248-1254DOI: (10.1016/j.cgh.2007.09.011) Copyright © 2007 AGA Institute Terms and Conditions

Figure 4 (A) Reactive ductal epithelium. There is mild disorganization of the epithelial architecture, uniform nuclear enlargement, and almost all cells show prominent nucleoli (PAP, 400×). (B) Well-differentiated pancreatic adenocarcinoma. Although the epithelial architecture is almost normal, the cells are beginning to lose polarity, the nucleoli are markedly pronounced, and there is some anisonucleosis. There is a background of necrotic debris and neutrophils which may be seen in benign and malignant lesions. (C) Pancreatic adenocarcinoma. The cells show overt malignant features: extreme nuclear enlargement, prominent anisonucleosis within the epithelial fragment, and marked nuclear membrane irregularity (PAP, 600×). Color version of these figures available at www.cghjournal.org. Clinical Gastroenterology and Hepatology 2007 5, 1248-1254DOI: (10.1016/j.cgh.2007.09.011) Copyright © 2007 AGA Institute Terms and Conditions

Figure 5 (A) Intraductal pancreatic mucinous neoplasm. The epithelial fragment shows cells with clearly delineated mucin-containing vacuoles (DiffQuik, 400×). (B) Duodenal mucosa. The cells are arranged in a perfectly regular honeycomb pattern, with goblet cells appearing as cleared spaces (DiffQuik, 400×). (C) Gastric mucosa. The edge of the fragment shows prominent polarization of the epithelium, and mucous-containing cells (PAP, 400×). Color version of these figures available at www.cghjournal.org. Clinical Gastroenterology and Hepatology 2007 5, 1248-1254DOI: (10.1016/j.cgh.2007.09.011) Copyright © 2007 AGA Institute Terms and Conditions

Figure 6 (A) Hepatocellular carcinoma. The smear shows cohesive clusters of markedly atypical cells. There are no features indicative of hepatocytic origin (PAP, 200×). (B) Cholangiocarcinoma. The cells are tightly clustered, with increased N/C ratios and nuclear enlargement (DiffQuik, 400×). Color version of this figure available at www.cghjournal.org. Clinical Gastroenterology and Hepatology 2007 5, 1248-1254DOI: (10.1016/j.cgh.2007.09.011) Copyright © 2007 AGA Institute Terms and Conditions

Figure 7 Seminal vesicle. The cell show marked anisonucleosis, however, there is no nuclear membrane irregularity and no nucleoli. The cytoplasm has vacuoles and pigment granules (DiffQuik, 400×). Color version of this figure available at www.cghjournal.org. Clinical Gastroenterology and Hepatology 2007 5, 1248-1254DOI: (10.1016/j.cgh.2007.09.011) Copyright © 2007 AGA Institute Terms and Conditions