1. Cytopathology Challenge!
Weekly Cases
Week of Nov 5th 2007

2. 1 51 year-old male with lung transplant. BAL. Reactive CMV
Bronchioloaveolar carcinoma
TB granulomatous changes
Non-small cell lung carcinoma 1

3. 2 67 year old female with pulmonary infiltrate. BAL.
Squamous cell carcinoma
Small cell carcinoma
Adenocarcinoma
Bronchioloalveolar carcinoma
Reactive 2

4. 3 34 year old female. ThinPrep pap Endocervical cells
Squamous metaplasia
ASCUS
LSIL
HSIL 3

5. 4 58 year-old male with lung mass. FNA cell block. Squamous metaplasia
Non-small cell lung carcinoma
Small cell carcinoma
Large cell variant neuroendocrine carcinoma
Granuloma 4

6. 5 44 year old female with “cold”
thyroid nodule. FNA demonstrated scant
colloid and sheets of these cells in
microfollicular pattern.
Follicular adenoma
Follicular carcinoma
Indeterminate
Papillary carcinoma
Medullary carcinoma 5

7. 6 34 year old female. ThinPrep pap Endocervical cells
Squamous metaplasia
ASCUS
LSIL
HSIL 6

8. 7 59 year old female with breast cancer and pleural effusion.
Pleural fluid cytospin.
Metastatic breast carcinoma
Reactive pulmonary macrophages
Reactive mesothelial cells
Viral inclusion
Mesothelioma 7

9. 8 29 year old female. ThinPrep pap Endometrial cells
Endocervical cells
ASC-US
LSIL
HSIL 8

10. 9 49 year old female with thyroid nodule. FNA DiffQuik A. Goiter
B. Graves disease
C. Cyst contents
D. Neoplasm
E. Hurthle cells/reactive 9

11. 10 67 year old male. Bladder wash. Reactive urothelial/umbrella cell
Papillary neoplasm – low grade
Papillary neoplasm – high grade
Squamous cell carcinoma
HPV effect 10

12. Answers A Reactive E Reactive – endobronchial cells and macrophages
Multi-nucleated bronchial epithelial cell. Sometimes they do that…not related to tumor or specific virus
E Reactive – endobronchial cells and macrophages
Open chromatin, reactive nucleoli. No tumor in this.
E HSIL
High NC ratio, irregular nuclei
B Non-small cell lung CA
Probably squamous. Too much cytoplasm for neuroendocrine or small cell. NC ratio and hyperchromatic nuclei would argue against granuloma
C Indeterminate
The scant colloid and sheets or follicular cells (photo) in a microfollicular pattern would suggest a follicular lesion, but we can’t assess adenoma vs carcinoma on FNA so we call them indeterminate.
D LSIL
Koilocytes again!
A Metastatic breast CA
Mucin in the cytoplasm – almost forming a signet ring.
B Reactive endocervical cells
Normal. No dysplasia in this one.
D. Neoplasm – Papillary thyroid carcinoma
See the nuclear pseudoinclusion…….
A Reactive urothelium/umbrella cell
They can be binucleate. Looks like HPV – but it’s urothelium and not related in any way to HPV in cervix