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Cytopathology Challenge! Weekly Cases

Cytopathology Challenge! Weekly Cases. January 20, 2009. 28 y/o female. Thin Prep. Atypical glandular cells (AGUS) HSIL Tubal metaplasia Benign endometrial cells Adenocarcinoma. 1.

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Cytopathology Challenge! Weekly Cases

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  1. Cytopathology Challenge! Weekly Cases January 20, 2009

  2. 28 y/o female. Thin Prep. • Atypical glandular cells (AGUS) • HSIL • Tubal metaplasia • Benign endometrial cells • Adenocarcinoma 1

  3. The cells are hyperchromatic and overlapping; however cilia is present. Tubal metaplasia of endocervical cells can often be confused for HSIL/AGUS, but cilia denotes a benign process. • 28 y/o female. Thin Prep. • Atypical glandular cells (AGUS) • HSIL • Tubal metaplasia • Benign endometrial cells • Adenocarcinoma 1

  4. 33 y/o female. Thin Prep Pap. Based on the cells shown above, what is the appropriate management for the patient? • Repeat cytology in 6 months • HPV molecular testing • Repeat cytology in 1 year • Colposcopy • Observation 2

  5. 33 y/o female. Thin Prep Pap. Based on the cells shown above, what is the appropriate management for the patient? • Repeat cytology in 6 months • HPV molecular testing • Repeat cytology in 1 year • Colposcopy • Observation All high grade lesions (HSIL) go straight to colposcopy. 2

  6. 18 y/o female. Thin Prep Pap. Based on the cells shown, what is the appropriate management for the patient? A. Repeat cytology in 6 months B. HPV molecular testing C. Repeat cytology in 1 year D. Colposcopy E. Observation 3

  7. 18 y/o female. Thin Prep Pap. Based on the cells shown, what is the appropriate management for the patient? A. Repeat cytology in 6 months B. HPV molecular testing C. Repeat cytology in 1 year D. Colposcopy E. Observation For adolescents (20 years and younger), the new guidelines recommend repeat cytology at 12 months for both ASCUS and LSIL 3

  8. 45 y/o female. FNA of thyroid. • Reactive, neg for malignancy • Goiter • Indeterminate for malignancy. • Papillary carcinoma. • Hashimoto’s thyroiditis 4

  9. Cluster of lymphocytes and dispersed lymphs in the background Oncocytes • 45 y/o female. FNA of thyroid. • Reactive, neg for malignancy • Goiter • Indeterminate for malignancy. • Papillary carcinoma. • Hashimoto’s thyroiditis 4

  10. 54 y/o female. Thin Prep pap. • HSIL • Adenocarcinoma • Benign endocervical cells • Benign endometrial cells • Squamous cell carcinoma 5

  11. Glandular cells with large pleomorphic nuclei and prominent nucleoli. Can appreciate some overlapping/architectural disorder. • 54 y/o female. Thin Prep pap. • HSIL • Adenocarcinoma • Benign endocervical cells • Benign endometrial cells • Squamous cell carcinoma 5

  12. 23 y/o female. Thin Prep pap. • ASCUS • Squamous metaplasia • HSIL • Endocervical cells • LSIL 6

  13. 23 y/o female. Thin Prep pap. • ASCUS • Squamous metaplasia • HSIL • Endocervical cells • LSIL 6

  14. FNA of salivary gland mass. PAP stain A. Pleomorphic adenoma B. Mucoepidermoid carcinoma C. Normal salivary gland D. Adenoid cystic carcioma E. Myoepithelioma 7

  15. Myoepithelial cells embedded in stroma Chondromyxoid stroma is present here. In this case, it is lacking the typical “fibrillary” appearance. FNA of salivary gland mass. PAP stain A. Pleomorphic adenoma B. Mucoepidermoid carcinoma C. Normal salivary gland D. Adenoid cystic carcioma E. Myoepithelioma 7

  16. 55 yo female. Breast mass. FNA • Benign ductal cells • Fibroadenoma • Apocrine metaplasia • Breast carcinoma • Phyllodes tumor 8

  17. Disorderly sheets of crowded cells. Cells are pleomorphic, nuclear enlargement, coarse chromatin and prominent nucleoli. • 55 yo female. Breast mass. FNA • Benign ductal cells • Fibroadenoma • Apocrine metaplasia • Breast carcinoma • Phyllodes tumor 8

  18. 75 yo female with idiopathic fibrosis. BAL • Candida • Aspergillus species • Pneumocystis • CMV • Amoeba 9

  19. 75 yo female with idiopathic fibrosis. BAL • Candida • Aspergillus species • Pneumocystis • CMV • Amoeba Just to prove you can see fungus on Pap stain. If only the boards were this easy… 9

  20. 44 yo female with liver lesion. FNA • Positive – c/w hepatocellular carcinoma • Positive – c/w melanoma met • Positive – c/w colon cancer met • Benign liver cells • Benign bile duct cells 10

  21. 44 yo female with liver lesion. FNA • Positive – c/w hepatocellular carcinoma • Positive – c/w melanoma met • Positive – c/w colon cancer met • Benign liver cells • Benign bile duct cells 10

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