August 1st, 2008

54 year old female. ThinPrep pap A.Trichomonas B.Lactobacillus C.Atrophy D.Bacterial vaginosis E.Artifact 1

2 34 year old female. ThinPrep pap A.Reactive endocervical cells B.Squamous metaplasia C.AGUS D.LSIL E.HSIL

3 31 year old female. ThinPrep pap A.Endocervical cells B.HSIL C.Endometrial cells D.Benign reactive sq. cells E.LSIL

4 59 year old male smoker. Bronchoalveolar lavage. A.Benign bronchial cells. B.Suspicious for malignancy. C.Sq. cell carcinoma. D.AdenoCa. E.PCP.

5 64 year old male. FNA of subcarinal lymph node. A.Lymphoma B.Suspicious for malignancy C.Small cell carcinoma D.AdenoCa E.Squamous cell carcinoma

63 yo male with omental tumor. FNA. A.Reactive, neg for malignancy B.Amoeba C.Metastatic carcinoma D.Malignant mesothelioma E.Metastatic melanoma 6

7 89 year old female with thyroid nodule. ThinPrep pap A.Colloid nodule B.Benign follicular cells C.Medullary carcinoma D.Papillary thyroid carcinoma E.Hurthle cell carcinoma

8 54 yo female. Urine specimen. A.Unsatisfactory specimen B.Candida C.High grade TCC D.Amoeba E.Filamentous bacteria

9 64 year old male. Urine. A. Umbrella cell B. Polyoma virus C. High grade TCC D. Negative for TCC E. Inflammatory changes

10 71 yo female. Pancreas FNA. A.Amoeba B.Benign acinar cells C.Benign ductal cells D.Adenocarcinoma E.Pseudocyst

Answers 1.Atrophy: predominance of parabasal cells. No dysplastic cells seen. 2.AGUS: glandular cells with enlarged, hyperchromatic, irregular nuclei. The eccentric nucleus and vacuolated cytoplasm are clues to glandular origin. 3.Benign reactive squamous cells: The nuclei are not enlarged. Binucleation can be seen in reactive cells and does not automatically mean LSIL. PMN’s in the background. 4.Benign bronchial cells: note the cillia. 5.Small cell carcinoma: large nuclei (bigger than lymphocyte nuclei) with high N:C ratios, nuclear molding, “salt and pepper” chromatin, and mitotic figures. 6.Metastatic carcinoma: if you chose melanoma or mesothelioma you are also right because on this picture it would be impossible to rule those out. This turns out to be metastatic carcinoma, best categorized as hepatoid carcinoma (HepPar1 and CK-7 positive, CK-20 neg). 7.Papillary thyroid carcinoma: notice the enlarged nucleus with a classic intranuclear inclusion. Nuclear grooves and fine chromatin were obvious on the Pap stain. 8.Candida: conidia (yeast) and pseudohyphae. 9.High grade TCC: eccentrically located, markedly enlarged nucleus with dark chromatin. 10.Pancreatic adenocarcinoma: compare the nuclear size of the cells at the top left to the benign ductal cells arranged in a honeycomb pattern. Notice the high cellularity and the tumor diathesis in the background.