Cytology Cases of the Week - Prior
Faculty: Annemieke Van Zante, MD, PhD
Tuesday, January 26, 2021
| Case 808 |
| History
47 year-old man with a history of a lymphoproliferative disorder presents with large left sided pleural effusion. Thoracentesis extracts 1200 ml of light green cloudy fluid.
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Diagnosis:
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Involved by plasma cell myeloma
Description: The aspirate shows abundant dyshesive atypical cells with enlarged, eccentrically placed nuclei, coarse chromatin, prominent nucleoli and perinuclear hof. Bizarre binucleated and multinucleated forms are also present. CD138 is a plasma cell marker. The atypical cells were also positive for CD56 and only expressed lambda light chain. These findings are consistent with involvement by plasma cell myeloma in this patient with advanced multiple myeloma.
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| Case 809 |
| History
73 year old woman with incidental 1.7 cm left thyroid nodule.
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Diagnosis:
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Benign thyroid nodule with chronic thyroiditis
Description: The aspirates show a predominant population of oncocytes in a background of lymphocytes. The oncocytes (Hurthle cells) are characterized by their greyish blue cytoplasm, round nucleus, and a central prominent nucleolus. Cracked colloid is also present. These findings are consistent with chronic lymphocytic thyroiditis. Therefore the nodule is categorized as Bethesda Category II (Benign).
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| Case 810 |
| History
EUS-FNA of a pancreatic mass in a 38 year-old man with a history of alcohol use and one year of abdominal discomfort, loose stools, and weight loss. CT showed an 8 cm pancreatic neck mass with upstream dilatation of the pancreatic duct and parenchymal atrophy encasing surrounding vessels, with numerous hepatic lesions consistent with metastases and metastatic retroperitoneal lymphadenopathy.
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Diagnosis:
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Neuroendocrine tumor
Description: The smears are abundantly cellular and reveal loosely cohesive uniform cells with scant cytoplasm, round nuclei with finely stippled chromatin, and conspicuous small nucleoli. Some of the cells show pseudorosette arrangement and nuclear molding. No mitoses and apoptoses are identified. The background contains rare stromal fragments. The cell block demonstrates similar tumor cells in a solid to nested arrangement. Immunoprofile supported a NET (Pankeratin +, Synaptophysin +, CD56+, Ki-67 3-5%). The grading of NET is based on mitosis count and Ki-67 which in this case would be G2 (2-20 mitoses in 2 mm2 or Ki-67 index 3-20%). A disclaimer should be made that grading on FNA is provisional and a follow-upresection may reveal higher grade areas. Clinical follow-up showed elevated VIP and Insulin consistent with a VIPoma.
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| Case 811 |
| History
50 year old man presents with a segment 4A liver lesion (3.3 cm heterogeneous enhancement on CT).
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Diagnosis:
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Metastatic adenocarcinoma (extra point for mentioning colorectal primary)
Description: The aspirate smears are abundantly cellular and reveal cohesive clusters of tumor cells in a background of necrosis and few fragments of normal hepatic tissue. The tumor cells have abundant soft cytoplasm with occasional vacuoles and pleomorphic enlarged oval nuclei with irregular nuclear contours, clumpy chromatin and occasional prominent nucleoli. The cell block is concordant and shows tumor fragments with cribriform architecture. These findings are those of a metastatic adenocarcinoma. The most common metastasis to the liver are colorectal, lung, breast, and pancreatic carcinomas. Certain features of this tumor including the columnar cell appearance, dirty necrosis in the background and the cribriform architecture (more evident on the cell block) are characteristic of a colorectal tumor. The immunoprofile supports this hypothesis (CK7-, CK20+, CDX2+). The patient had a colonoscopy which discovered a rectal mass.
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