1. Cytopathology Challenge!
Weekly Cases
October 29th, 2007

2. 1 35 year old male with parotid mass on right side. FNA smear.
Warthin Tumor
Pleomorphic adenoma
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Acinic cell carcinoma 1

3. 2 68 year old male with stricture in common bile duct.
Reactive epithelium
Squamous cell carcinoma
Adenocarcinoma
Islet cell tumor
Plasma cell neoplasm 2

4. 3 64 year old with liver mass. FNA of celiac node. Germinal center
Benign hepatocytes
Hepatitis C cytopathic changes
Hepatocellular carcinoma
Hepatic adenoma 3

5. 4 51 year old male with hematuria. Bladder Washing. Polyoma Virus
“Umbrella” cells
Low grade urothelial carcinoma
PUNLMP
High grade urothelial carcinoma 4

6. 5 24 year old female. ThinPrep pap Parakeratosis ASCUS LSIL HSIL
Squamous cell carcinoma 5

7. 6 49 year old female with pelvic mass. FNA lymph node.
Squamous metaplasia
Reactive Germinal center
Sarcoidosis
Metastatic tumor
Histiocytosis 6

8. 7 68 year old male with hematuria A. Polyoma Virus
B. Umbrella cell and reactive urothelial cells
C. Low grade urothelial carcinoma
D. PUNLMP
E. High grade urothelial carcinoma 7

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

10. 9 47 year old female with esophageal submucosal nodule.
FNA cell block.
Leiomyoma
Skeletal muscle
Neuroma
Fibroma
Sarcoma 9

11. 10 66 year old female with pulmonary nodule. FNA.
Reactive endobronchial cells
Reactive macrophages
Non-small cell lung CA
Small cell lung CA
Adenovirus. 10

12. Answers A Warthin Tumor A Reactive Epithelium
One image shows lymphocytes + the other shows the epithelium = Warthin tumor
A Reactive Epithelium
Small regular nuclei and honeycomb appearance. Reactive ductular epithelium.
D Hepatocellular carcinoma
Mitoses and big ugly nuclei with necrosis in background.
E High grade urothelial carcinoma
High NC ratio, hyperchromatic irregular nucei
A Parakeratosis
Nuclei not enlarged or irregular. Not koilocytes or HPV.
D Metastatic carcinoma
Ugly pleomorphic tunmor cells replacing a node. Node metastasis in a patient with cervical cancer.
B Umbrella cell and reactive urthelial cells
The big one if the umbrella cell and the small ones are just reactive urothelial cells. Both normal.
D LSIL
Koilocytes !!!!!!!
A Leiomyoma
Smooth muscle only
C Non-Small cell Lung CA
High NC ratio, pleomorphic hyperchromatic nuclei.