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Cytopathology Challenge! Weekly Cases

Cytopathology Challenge! Weekly Cases. Oct 31, 2008. Mixture of lymphocytes and follicular cells. 44 y/o female. FNA of thyroid. Unsatisfactory due to insufficient cellularity. Lymphocytic thyroiditis. Goiter Indeterminate. Papillary carcinoma. 1. Bronchoalveolar lavage.

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Cytopathology Challenge! Weekly Cases

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  1. Cytopathology Challenge! Weekly Cases Oct 31, 2008

  2. Mixture of lymphocytes and follicular cells. • 44 y/o female. FNA of thyroid. • Unsatisfactory due to insufficient cellularity. • Lymphocytic thyroiditis. • Goiter • Indeterminate. • Papillary carcinoma. 1

  3. Bronchoalveolar lavage. • Unsatisfactory. • Malignant cells present. • PCP • Strongyloides • Artifact 2

  4. Thyroid FNA • Colloid with cholesterol crystals. • Indeterminate. • Papillary carcinoma. • Anaplastic carcinoma. • Metastatic carcinoma. Large rectangular cholesterol crystals commonly seen in goiter 3

  5. Others are large and hyperchromatic. Some of the malignant cells are splindled. • FNA of thigh mass. • Negative for malignancy. • Sq. cell carcinoma. • AdenoCa. • Sarcoma. • Abscess. 4

  6. Bronchoalveolar lavage. • Unsatisfatory. • Negative for malignancy. • Small cell carcinoma • AdenoCa • Squamous cell carcinoma Benign ciliated bronchial cell Pigmented macrophages are needed for an adequate sample 5

  7. FNA of thyroid. • Reactive, neg for malignancy • Goiter • Indeterminate for malignancy. • Papillary carcinoma. • Follicular carcinoma. This papillary structure viewed at high power demonstrates cells with high N/C ratios, hyperchromasia, and intranuclear inclusions. Intranuclear inclusion 6

  8. 54 yo female with pleural effusion • Reactive mesothelial cells • Adenocarcinoma • Mesothelioma • Melanoma • Lymphoma This “cannon ball” of tumor cells is characteristic for breast carcinoma in pleural fluid. Other adenocarcinomas may form large proliferation spheres as well. Adenoca’s have smooth community borders, whereas mesotheliomas tend to have a more knobby outline. 7

  9. FNA of pancreatic mass. • Unsatisfactory specimen • Reactive cells • Pseudocyst contents • Pancreatic adenocarcinoma • Amebiasis Compare the malignant cells to the reactive ductal cells arranged in a orderly honeycomb pattern. The malignant cells are less cohesive. Did you notice the tumor diathesis in the background? 8

  10. GMS of corneal scrape A. PCP B. Acanthamoeba C. Fungus D. Fuch’s corneal dystrophy E. Toxic epidermal necrolysis Acanthamoeba has a spiky outline. 9

  11. Instrumentation effect. • 61 yo bladder wash s/p TURP. • Benign changes. • Fungus • Smooth muscle neoplasm • Schistosomiasis • High grade TCC 10

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