Cytologie du rein et de la glande surrénale

Question 1

FNA rénale

Answer 1

Glomérule

Question 1

FNA rénale

Answer 1

Glomérule

Question 2

FNA d’une masse rénale

Answer 2

Oncocytome

Smears show noncohesive cells with abundant granular cytoplasm and well-demarcated cell membranes. Nucleoli are evident (Papanicolaou stain).

Question 3

FNA d’une masse rénale

Answer 3

Angiomyolipome

(A) Cohesive tissue fragments comprised of spindle-shaped smooth muscle cells are usually the predominant finding (Papanicolaou stain). (B) Occasionally, thick-walled blood vessels are seen (Romanowsky stain).

Question 4

FNA d’une masse rénale

Answer 4

Adénome métanéphrique

(A and B) Smears show short tubules, cords, and tight balls of cells with scant cytoplasm (A, Papanicolaou stain; B, Romanowsky stain).

Question 5

FNA d’une masse rénale pédiatrique

Answer 5

Tumeur de Wilms

(A) This image illustrates only the blastemal component, which often predominates. Blastema cells are small to medium-sized, round-to-ovoid cells with scant cytoplasm (Papanicolaou stain). (B) Blastema resembles small round cell tumors. Note the conspicuous cellular molding. Five cells in the upper right suggest a possible tubular arrangement (Romanowsky stain).

Question 6

FNA rénale

Answer 6

Pyélonéphrite xanthogranulomateuse

(A) Histocytes with abundant granular cytoplasm bear some resemblance to the cells of an oncocytic tumor (hematoxylin and eosin [H & E] stain).

Question 7

FNA rénale

Answer 7

Macrophages

Macrophages are a nonspecific finding (Papanicolaou stain).

Question 8

FNA rénale

Answer 8

Anneaux de Liesegang

These sharply defined round crystal-like structures have a double-layered outer wall and radial striations. Often seen in association with benign renal cysts, they are a nonspecific finding (A, Papanicolaou stain; B, hematoxylin and eosin stain).

Question 9

FNA d’une masse rénale

Answer 9

Carcinome à cellules claires

(A) The tumor cells are in a broad sheet and have abundant clear and granular cytoplasm (Papanicolaou stain).

Question 10

FNA d’une masse rénale

Answer 10

Carcinome à cellules claires

(B) Fine cytoplasmic vacuoles and pink, strand-like material (arrow) are well seen with the Romanowsky stain.

Question 11

FNA d’une masse rénale

Answer 11

Carcinome à cellules claires

(C) Nuclei are often eccentrically placed (Papanicolaou stain).

Question 12

FNA d’une masse rénale

Answer 12

Carcinome à cellules claires

(D) The cytoplasm of this grade 4 tumor is more opaque, the cells are more dyshesive, and nucleoli are prominent (Romanowsky stain).

Question 13

FNA d’une masse rénale

Answer 13

Carcinome à cellules claires

(A) Sarcomatoid changes. The malignant cells are haphazardly arranged and very elongated

Question 14

FNA d’une masse rénale

Answer 14

Carcinome à cellules claires

(B) Rhabdoid changes. The cells are large, with an eccentrically placed nucleus and a conspicuous focus of cytoplasmic condensation. Sarcomatoid and rhabdoid changes indicate a worse prognosis (Romanowsky stain).

Question 15

FNA d’une masse rénale

Answer 15

Carcinome rénal papillaire

(A) Complex papillary architecture is apparent on smears. Note the large sphere (arrow), a characteristic finding. Foamy macrophages are scattered in the background (Papanicolaou stain). (B) Foamy macrophages stuff the fibrovascular cores of the papillae and are often best seen on cell block sections (hematoxylin and eosin stain). (C) Note how round and monomorphous the nuclei are in a low-grade papillary renal cell carcinoma (Papanicolaou stain). (D) Cytoplasmic hemosiderin is a common finding (Romanowsky stain).

Question 16

FNA d’une masse rénale

Answer 16

Carcinome papillaire rénal oncocytaire

(A) The tumor cells form complex papillary structures but are also dispersed as isolated cells (Romanowsky stain). (B) Cell block sections reveal papillae lined by a single layer of oncocytic cells (hematoxylin and eosin stain). The lesional cells were strongly positive for GATA3 (not shown).

Question 17

FNA d’une masse rénale

Answer 17

Carcinome rénal chromophobe

(A) The tumor cells have a koilocytoid appearance, with abundant cytoplasm, prominent cell borders, binucleation, and dark nuclei that vary in size. Nucleoli are hard to see (Papanicolaou stain). (B) The fluffy, irregularly vacuolated cytoplasm has a moth-eaten appearance (Romanowsky stain).

Question 18

FNA d’une masse rénale

Answer 18

Carcinome urothélial

Cells with long unipolar cytoplasmic extensions and flared ends are called cercariform cells (Papanicolaou stain).

Question 19

FNA d’une masse surrénalienne

Answer 19

Adénome cortico-surrénalien

(A) Nuclei are stripped of cytoplasm and float in a sea of frothy cytoplasmic remnants (Papanicolaou stain).

Question 20

FNA d’une masse surrénalienne

Answer 20

Adénome corticosurrénalien

(B) Adjacent nuclei occasionally show molding (arrow) and thus mimic small cell carcinoma (Romanoswky stain).

Question 21

FNA d’une masse surrénalienne

Answer 21

Adénome corticosurrénalien

(C) Intact cells have indistinct cell borders (Papanicolaou stain).

Question 22

FNA d’une masse surrénalienne

Answer 22

Phéochromocytome

(A) In some cases there is marked anisonucleosis (Romanowsky stain).

Question 23

FNA d’une masse surrénalienne

Answer 23

Phéochromocytome

(B) Intranuclear cytoplasmic pseudoinclusions, a characteristic but nonspecific feature, are sometimes seen (Papanicolaou stain).