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Carlie S. Sigel, MD, Andre L. Moreira, MD, PhD, William D

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1 Subtyping of Non-small Cell Lung Carcinoma: A Comparison of Small Biopsy and Cytology Specimens 
Carlie S. Sigel, MD, Andre L. Moreira, MD, PhD, William D. Travis, MD, Maureen F. Zakowski, MD, Raymond H. Thornton, MD, Gregory J. Riely, MD, PhD, Natasha Rekhtman, MD, PhD  Journal of Thoracic Oncology  Volume 6, Issue 11, Pages (November 2011) DOI: /JTO.0b013e d Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

2 FIGURE 1. Examples of rare cases with discrepant adenocarcinoma (ADC) versus squamous cell carcinoma (SQCC) diagnoses in biopsy and cytology. A and B, ADC identified as SQCC by cytology with correct diagnosis of ADC in concurrent biopsy. Cytology (A) shows carcinoma cells with dense blue cytoplasm mimicking SQCC. Concurrent biopsy (B) shows poorly differentiated non-small cell carcinoma, which was diffusely positive for TTF-1 (not shown) supporting ADC. C and D, SQCC identified as ADC by cytology with correct diagnosis of SQCC in concurrent biopsy: Cytology (C) shows three-dimensional clusters of nonkeratinizing cells with prominent nucleoli, closely mimicking ADC. (D) Poorly differentiated carcinoma with focal squamous whorls diagnostic of SQCC is seen on the corresponding biopsy. E and F, ADC identified as SQCC by biopsy with correct diagnosis of ADC in concurrent cytology: Polarized (eccentric) nuclei and granular cytoplasm support ADC in cytology (E). Tumor cells in concurrent biopsy (F) have abundant pink cytoplasm and sharp cell borders mimicking SQCC. This tumor was found to be diffusely positive for TTF-1 and negative for p63, supporting ADC (not shown). A, C, and E, Papanicolaou stain, ×400. B, D, and F, H&E stain, ×400. Journal of Thoracic Oncology 2011 6, DOI: ( /JTO.0b013e d) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

3 FIGURE 2. Definitive morphologic evidence of squamous or glandular differentiation is frequently more apparent in cytologic preparation than biopsies. Cytology specimen (A) shows definitive keratinization (dense red or orange cytoplasm) diagnostic of squamous cell carcinoma. In contrast, keratinization is inapparent in concurrent biopsy (B) which required immunohistochemistry (IHC, positive p63; C) for the diagnosis. IHC for TTF-1 was negative (not shown). Cytology specimen (D) shows eccentric nuclei with flat luminal edge (arrow) diagnostic of adenocarcinoma. In contrast, morphologic differentiation is inapparent in concurrent core biopsy (E) and required IHC (positive TTF-1; F) for the diagnosis. A and D, Papanicolaou stain, ×400. B and E, H&E stain, ×400. C and F: Immunohistochemistry for p63 and TTF-1, respectively, ×400. Journal of Thoracic Oncology 2011 6, DOI: ( /JTO.0b013e d) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

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