1. KCP 서울대학교 병원 전공의 최은오

2. History 52/M 특별한 병력은 없고 30갑년의 흡연력이 있음
15일전부터 흉통이 있어 타병원에서 시행한 흉부영상에서 흉막 삼출 및 폐종괴가 발견됨
CT: 우중엽에 장경 1cm크기의 경계가 좋은 종괴, 우측 흉강 하부에 국한된 흉막 삼출이 동반되어 있었음
PET/CT: 종괴에 대한 FDG흡수 증가
종괴에 대한 세침 흡인 검사의 도말 슬라이드

10. Cytologic features Background
Proteinaceous fluid with many hemosiderin or anthracotic pigment-laden macrophages
Cellularity
Moderate
Architecture
Scattered epithelial cell clusters exhibiting papillary, sometimes ill-formed acini, rosette-like pattern
Cell
Small to medium in size
Round or columnar cells
Relatively bland-looking, but occasionally large cells with mild to moderate nuclear pleomorphism and nuclear hyperchromasia
Cytoplasm
Small to moderate amount of cytoplasm
Nucleus
Mostly, uniform round to oval nuclei
Smooth to irregular nuclear contour
Fine, stippled chromatin pattern
Inconspicuous nucleoli
Intranuclear inclusion

11. Differential diagnosis
Adenocarcinoma with lepidic pattern
Carcinoid tumor
Papillary adenoma
Sclerosing hemangioma

12. Clinical and radiologic features
ADC with lepidic pattern
Carcinoid tumor
Sclerosing
hemangioma
Papillary
adenoma
Less commonly associated with smoking than other types of NSCLC
Less than 4% of NSCLCs
May present as single or multiple nodules
1-2% of all lung tumors
From childhood to the ninth decades (mean age: 47years)
Similar frequencies in men and women
Mostly, central masses causing bronchial obstruction
Marked female predilection (80%)
Peak incidence in fifth decade
Mostly, solitary lesion
Multifocal in 4% of cases
Rare incidence
Males appear to predominate
Between 7 and 60 years
Peripheral parenchymal lesion

13. ADC with lepidic pattern Carcinoid tumor Sclerosing Hemangioma
Papillary
adenoma
Highly cellular aspirates with bland cuboidal to columnar cells in papillary clusters or flat sheets
Round to oval nuclei of uniform size
Nuclear membrane folds and grooves
Intranuclear pseudoinclusions
Cells occur singly and in clusters
Stripped nuclei
Small plasmacytoid cells and/or spindled cells
Scan to moderate cytoplasm
Stippled granular chromatin
Papillary clusters of bland-looking mononuclear cells
Hyalinized stromal tissue fragments
Some scattered epithelial cells with nuclear pleomorphism and intranuclear inclusions
Hemosiderin-laden macrophages in the background
Epithelial cell clusters of sheet or papillary pattern
Round to oval nuclei
Mild nuclear atypia
Fine chromatin pattern, sometimes small nucleoli
Scanty cytoplasm, high N/C ratio

14. Cytologic diagnosis
MICRO (2 pap) Lung, aspiration cytology: Adenocarcinoma with lepidic pattern