Nongyn Cytopathology Flashcards
What do you want to see as proof of a good respiratory sample?
Alveolar macrophages to prove that the terminal airways have been sampled. Just bronchial epithelial cells are not enough as they can be from larger airways
Identify in terms of respiratory cytology
Squamous metaplasia
identify in terms of respiratory cytology?
Atypical squamous metaplasia, nulcear enlargement, dyskaratosis
Identify in terms of respiratory cytology?
Describe?
Cause?
Pulmonary Alveolar Proteinosis
Composed of granular proteinaceous debris (usually more dense then what you would see with pneumocystis jiroveci)
Caused by macrophage function disfunction
Identify in terms of respiratory cytology?
Squamous cell carcinoma, severe atypia necrosis, dyskeratosis
Identify in terms of respiratory cytology….
Features microscopically?
What would you do next?
pneumocystis jiroveci
Will have intraalveolar eosinophillic proteinacious material and may have plasma-cell rich inflammation
GMS stain to highlight the organisms
Identify in terms of respiratory cytology….
pneumocystis jiroveci
What is an encoruaging benign feature in terms of respiratory cells?
The presence of cilia
Identify in terms of respiratory cytology?
Adenovirus infection
Identify in terms of respiratory cytology….
CMV
In what 2 conditions would you see a lot of these?
Identify?
Curschmann’s Spirals
Asthma or bronchiectasis
Identify in terms of respiratory cytology
Strongyloides infection
Identify in terms of respiratory cytology?
What is this associated with?
charcot leyden crystals
Asthma
Identify in terms of respiratory cytology
Creola body (right) next to adenocarcinoma (left). Notice that there are no cilia and the nuclei are larger in adenocarcinoma
Identify in terms of respiratory cytology
Coccidioides spherule
Contains endospores
Identify in terms of repiratory cytology?
Describe?
What is this associated with?
Creola bodies
Round, dense clusters of reactive bronchial cells (represent detached papillary hyperplasia). Should have cilia if you look hard
Asthma
Identify in terms of respiratory cytology?
blastomycosis
Broad based budding
What is this in terms of respiratory cytology?
ferruginous body
Fibers of asbestos coated with an iron-rich material derived from proteins such as ferritin and hemosiderin
Identify in terms of respiratory cytology?
Cryptococcus
The picture on the left is yeasts being engulfed by a histiocyte, on the left it’s a mucincarmine stain
Identify in terms of respiratory cytology?
Describe typical features
What general location does this usually present in the lung?
Adenocarcinoma
Malignant glandular cells without cillia and prominant nucleoli, intracytoplasmic mucin is diagnostic, but not all Adenoca have mucin
Peripherally
What does this represent in the context of respiratory cytology?
Describe?
Mesothelial cells
Arranged in flat, cohesive sheets
Cells have round or oval nuclei and small nuceoli with windows
What does this represent in the context of respiratory cytology?
Describe?
Reactive bronchial cells
Marked variation in nuclear size but retention of cilia
What does this represent in the context of respiratory cytology?
Describe?
Reserve cell hyperplasia
Clusters of benign cells with hyperchromatic nuclei and molding. Notice how small they are compared to the bronchial cells (right), this is a key feature to distinguish from small cell carcinoma
What does this represent in the context of respiratory cytology?
Describe features and pathophysiology?
Type II pneumocyte hyperplasia
Occurs in patients with acute lung injury, Enlarged type II pneumocytes with prominant nucleoli. Be careful as patient’s with lung cancer are often not acutely ill at presentation (like these patients would be)
What does this represent in the context of respiratory cytology?
Describe features and pathophysiology?
Curschmann Spiral
Coils of insspisated (thickened) mucus
What does this represent in the context of respiratory cytology?
Clinical significance?
Spherical structures matching those in the prostate, found in older individuals.
No clinical significance
What does this represent in the context of respiratory cytology?
Alternaria, a pigmented fungus that often contaminates (rarely pathologic)
Identify and describe each type of pulomnary viral infection?
Herpes- Multinucleation, margination, molding
CMV- Large intranuclear , small intracytoplasmic inclusions (basophillic)
Measles- Multinucleation but intranuclear and cytoplasmic inclusions (eosinophillic)
RSV- Multinucleation, Necrosis
Adenovirus- Large intranuclear inclusion filling the entire nucleus, decapitated cilia
Identify in context of respiratory cytology?
Features?
Adenovirus
A large inclusion (basophillic) filling the entire nucleus, decapitated cilia
Identify in context of respiratory cytology?
Features?
CMV
Large intranuclear and/or small cytoplasmic inclusions (basophillic)
Identify in context of respiratory cytology?
Features?
Herpes
Molding, margination, multinucleation
Identify in context of respiratory cytology?
Features?
Herpes
Molding, margination, multinucleation
Identify in context of respiratory cytology?
Features?
RSV
Multi-nucleation
Identify in context of respiratory cytology?
Features?
Pneumocytis Jiroveci
Proteinaceous spheres, GMS reveals the organisms
Identify in context of respiratory cytology?
Features?
Wegener granulomatosis
Granular background debris with necrotic collagen, but no acute inflammation
Identify in context of respiratory cytology?
Features?
Pulmonary alveolar proteinosis
A rare disease caused by accumulation of lipid-rich material within the alveoli. Results from macrophage disfunction.
Identify in context of respiratory cytology?
Features?
Squamous cell carcinoma
Cells with dense, orangeophillic cytoplasm with hyperchromatic nuclei with angulated contours. Also elongated spindle-like cells are common.
Identify in context of respiratory cytology?
Features?
Squamous cell carcinoma
Cells with dense, orangeophillic cytoplasm with hyperchromatic nuclei with angulated contours. Also elongated spindle-like cells are common.
Identify in context of respiratory cytology?
Typical features?
Architecture?
Nuclear shape?
Chromatin?
Cytoplasmic features (3)
Adenocarcinoma
Honeycomb sheets and 3d clusters
Round or irregular nuclei
Finely textured chromatin
Mucin Vacuoles, translucent and foamy cytoplasm
Identify in context of respiratory cytology?
Typical features?
Architecture?
Nuclear shape?
Chromatin?
Cytoplasmic features (2)
Adenocarcinoma
Sheets with a honey-comb like appearence
Round or irregular nuclei
Finely textured chromatin with large nucleoli
Mucin vacuoles, tranlucent/foamy cytoplasm
Identify in context of respiratory cytology?
Features?
Bronchoalveolar adenocarcinoma
Sheets of cells
Pale nuclei
Small nucleoli
Occasional grooves
Occasional pseudoinclusions (arrow)
Identify in context of respiratory cytology? How is this diagnosed?
What tumors are included under this one?
Features?
Large cell carcinoma- An undifferentiated non-small cell tumor that is a diagnosis of exclusion (doesn’t have squamous or glandular architecture)
An umbrella term with many variants, including large cell neuroendocrine tumor (also basoloid carcinoma, lymphoeputheioma like carcinoma, clear cell carcinoma etc)
Identify in context of respiratory cytology?
Features?
Large cell neuroendocrine carcinoma
Prominant nucleoli, carcinoid-like nuclei but with extreme atypia, enlargement, and frequent mitosis
Identify in context of respiratory cytology?
Features?
A common architectural arrangement?
Cytoplasm?
Chromatin pattern?
Typical carcinoid tumor
Rosettes
Coursely granular cytoplasm
Salt-and-pepper
Identify in context of respiratory cytology?
Features (compare to more benign version)
Atypical carcinoid tumor
Compared to typical carcinoid has more pleomorphism, slight enlargement, increased mitosis, focal necrosis, and sometimes prominant nucleoli
Identify in context of respiratory cytology?
Features?
Nuclear size?
Nuclear features?
Cell features?
Small cell carcinoma
Enlarged nuclei compared to typical (twice the size of a lymphocyte)
Nuclear molding with evenly dispersed and powdery chromatin
Tightly pack cells, fragile and frequently degenerated or crushed
Identify in context of respiratory cytology?
Features?
Architecture?
Nucleoli?
Key cytoplasmic feature for this?
Metastatic ductal breast carcinoma
Clusters of tumor cells
Prominant nucleoli
Intracellular mucin
(note, usually need IHC to identify)
What is the standard needed material for adequacy in a thyroid FNA?
A minimum of 6 groups of well-visualized, well stained, well preserved follicular cells with at least 10 cells each
What are the 3 exceptions for thyroid adequacy (do not have at least 6 groups of well preserved follicular cells with 10 cells each)
Any significant cytologic atypia, especially in a solid nodule
Solid nodules with inflammation (could indicate Hashimoto, absess, or granulomatous thyroiditis)
Colloid nodules with abdundant and thick colloid.
How would you diagnose this thyroid FNA?
Unsatisfactory, this is cilliated respiratory epithelium from accidentle puncture of the trachea
How would you diagnose this thyroid FNA?
Unsatisfactory
Extensive air-drying artifact prevents adequate assessment (not well visualized or perserved)
How would you diagnose this thyroid FNA if 6 well-preserved benign follicles were found elsewhere in the slide?
Benign follicular nodule
Thick colloid and benign follicles
How would you diagnose this thyroid FNA if 6 well-preserved benign follicles were found elsewhere in the slide?
Benign follicular nodule
Thick colloid and benign follicles
How would you diagnose this thyroid FNA if at least 6 well-preserved benign follicles were found total in the slide?
Benign, follicular nodule
How would you diagnose? (Thyroid FNA)
What condition could this patient have?
Describe typical cytologic features of this disease?
Architecture?
Cytoplasm (two key features)?
Nuclear size?
Nucleoli?
Benign follicular nodule
Graves disease
Large sheets of cells with abundant cytoplasm
Foamy cytoplasm, “flame cells” can be seen on DQ with marginal cytoplasmic vacuoles with red-pink frayed edges
Enlarged
Often prominant
How would you diagnose? (Thyroid FNA)
What condition could this patient have?
Describe typical cytologic features of this disease?
Architecture?
Cytoplasm (two key features)?
Nuclear size?
Nucleoli?
Benign follicular nodule
Graves disease
Large sheets of cells with abundant cytoplasm
Foamy cytoplasm, “flame cells” can be seen on DQ with marginal cytoplasmic vacuoles with red-pink frayed edges
Enlarged
Often prominant
How would you diagnose? (Thyroid FNA)
What condition could this patient have?
Describe typical cytologic features of this disease?
Benign follicular nodule
Hashimoto’s (lymphocytic) Thyroiditis
A pleomorphic population of lymphoid cells (different sized lymphocytes) with occasional plasma cells, can also have Hurthle cell change
How would you diagnose? (Thyroid FNA)
What condition could this patient have?
Describe typical cytologic features of this disease (including an interesting cytoplasmic change)
Benign follicular nodule
Hashimoto’s (lymphocytic) Thyroiditis
A pleomorphic population of lymphoid cells (different sized lymphocytes) with occasional plasma cells, can also have Hurthle cell change
How would you diagnose? (Thyroid FNA)
What condition could this patient have?
Describe typical cytologic features of this disease?
Benign follicular nodule
Granulomatous (sunacute) Thyroiditis
Epithelioid granulomas, mixed inflammatory cells, benign follicular cells
What situtation would qualify for Atypia of Undetermined Significance for thyroid in terms of….
Microfollicles?
Hurthle cells?
Follicular cell atypia?
Features of papillary carcinoma?
Lymphoid cells?
Sparsely cellular but the cells that are present form microfollicles
Sparsely cellular with mainly Hurtle cells
Atypia uncertain due to possible artifact (larger due to airdrying, smudgy chromatin, etc..)
Features of PTC (pale chromatin, grooves, enlarged nuclei) but the vast majority of the sample has benign follicular cells and/or abdundant colloid
Lymphoid cells are atypical but not so much so that a malignant diagnosis can be reached
How would you diagnose this thyroid FNA?
Why?
Atypia of undetermined significance
Air-drying leads to enlargement and suboptimal nuclear detail, making the diagnosis uncertain
How would you diagnose this Thyroid FNA?
Why?
Atypia of Undetermined Significance
Mostly benign cells but very rare atypical cells are present
What are the diagnostic criteria for Follicular neoplasm/suspicious for follicular neoplasm with thyroid FNA in terms of…..
Specimen cellularity?
Type of follicles?
Cell spacing?
Cell size?
Amount of cytoplasm?
Nuclear shape? Chromicity? Nucleoli?
Colloid?
Normo to hypercellular
Microfollicles (crowded, flat groups of less then 15 folliclar cells arranged in a circle that is at least 2/3s complete)
*Complicated definition but it seems like the idea is that they should not be too large or potentially a small piece of a large follicle (thus it must be 2/3rds complete
Cells are crowded and overlapping
Normal or enlarged
Scant to moderate cytoplasm
Round, hyperchromatic, inconspicuous nucleoli (however, may be enlarged)
Scant to absent colloid
<span>How would you diagnose this thyroid FNA?</span>
<span>Why?</span>
Follicular neoplasm/suspicious for follicular neoplasm
It has small follicles and overlapping nuclei
How would you diagnose this thyroid FNA?
Why?
Follicular neoplasm/suspicious for follicular neoplasm
Small follicles with crowded nuclei, also has enlarged nucleoli
How would you diagnose this thyroid FNA?
Why?
Follicular neoplasm/suspicious for follicular neoplasm
Small follicles with crowded nuclei, also has enlarged nucleoli
How would you diagnose this thyroid FNA?
Why?
Follicular neoplasm/suspicious for follicular neoplasm
Small follicles with crowded nuclei, also has enlarged nucleoli
What are the criteria for Follicular neoplasm, Hurthle cell type (Thyroid) in terms of….
Cytoplasm
Nucleus size, location, shape
Nucleolus
Cell size? N/C ratio?
Finely granular cytoplasm
Enlarged nucleus, centrally or eccentrically located, round shape
Prominant nucleous
Small cell dysplasia- Small cells with high N/C ratio
Large cell dysplasia- At least 2X variability in nuclear size
How would you diagnose (thyroid FNA)?
Why?
Follicular neoplasm/suspicious for follicular neoplasm, Hurtle cell type
This is the large cell dysplasia I think with nuclear size variation, note the abundant oncocytic cytoplasm
How would you diagnose (Thyroid FNA)?
Why?
Follicular neoplasm/suspicious for follicular neoplasm, Hurtle cell type
Hurtle cells in sheets and isolated cells. Note the pleomorphism with the large cells with more cytoplasm, and the small cells with less.
How would you diagnose? (Thyroid FNA)
Why?
Follicular neoplasm/suspicious for follicular neoplasm, Hurtle cell type
Loosely cohesive cells with markedly enlarged Hurthle cells and marked variation in size (large cell dysplasia), also note the large nuceoli
What is the diagnostic criteria for “Suspicious for Papillary Thyroid Cancer” in terms of….
Pattern A (Patchy nuclear changes pattern)?
Pattern B (incomplete nuclear changes)?
Pattern C (sparsely cellular pattern)?
Pattern D (Cystic degeneration pattern)?
Pattern A- Moderately to highly cellular with mostly benign follicular cells with some cells intermixed with features of PTC EXCEPT that pseduinclusions are rare or absent
Pattern B- Variably cellularity. nucleai are enlarged with pallor and grooves, but LACK NUCLEAR MEMBRANE IRREGULARITY AND NUCLEAR MOLDING. Pseudoinclusions are rare or absent
Pattern C- Features of PTC but a very sparsely cellular sample
Pattern D- Cells have some but not all features of PTC (often lacking pseudoinclusions). There is the presence of hemosiderin laden-macrophages thus implying a cystic degeneration process
What is the diagnostic criteria for “Suspicious for Medullary carcinoma” (Thyroid) in terms of..
Cellularity?
Cell cohesiveness?
N/C ratio?
Sparsely to moderately cellular
discohesive cells
High N/C ratio
The point is, this one could be confused for a lymphoma as well, that’s why it’s not definite
How you you diagnose? (Thyroid FNA)
Most cells in this sample looked benign FYI
Why?
Suspicious for PTC
Some features of PTC are there (enlargement, powdery chromatin, grooves) but most cells in this sample looked benign
Features of papillary Thryroid carcinoma in terms of……
Architecture?
Nuclear size?
Nuclear shape?
Grooves?
Pseudoinclusions?
Nuclear color?
Chromatin pattern?
Psammoma bodies?
Papillae and/or monolayers
Enlarged nuclei
Oval or irregularly shaped nuclei
Longitudinal nuclear grooves
Yes
Pale
Powdery chromatin
Often present
Common
How would you diagnose this (Thyroid FNA)?
Why?
Papillary thyroid carcinoma
Papillary structure and crowded nuclei
How would you diagnose this (Thyroid FNA)?
Why?
PTC, highly cellular with monolayers and papillary-like fragments
How would you diagnose this (Thyroid FNA)?
Why?
PTC
Intracytoplasmic nuclear pseudoinclusions, powerdey chromatin
How would you diagnose this (Thyroid FNA)?
Why?
PTC
We can see a multi-nucleated giant cell (a common feature)
The nuclei have powdery chromatin, grooves, and a pseudoinclusion
How would you diagnose this (Thyroid FNA)?
Why?
PTC, follicular variant
We have a microfollicle with nuclear features of PTC (enlargement of nuclei, intranuclear pseudoinclusions)
What is the oncocytic variant of PTC?
PTC with characteristic nuclear changes but mostly oncocytic type cells
What are the characteristic traits of PTC, tall cell varient?
Cell shape?
Cytoplastm?
Nuclear Changes?
Elonagated, at least 3 times taller then wide
Abdundant, dense, granular cytoplasm
Typical changes of PTC
What are the features of PTC, columnar cell variant in terms of
Nuclear shape and interaction?
Nuclear changes?
Elongated nuclei with stratification
Grooves and intranuclear inclusions LESS prominant then conventional type
Chromatin tends to be HYPERCHROMATIC rather then pale and powdery
What are the criteria for Medullary Thyroid cancer in terms of…
Cellularity?
Architecture?
Cell shape?
Nuclear shape? Placement?
Chromatin pattern?
Multinucleation?
Cytoplasm?
What other substance is also often present?
Isolated cells and small clusters
Varying shapes, including elongated, spindle shaped, and plasmacytoid
Round, eccentric
Coarsely or finely granular (salt and pepper)
Often bi or multi-nucleation
Granular cytoplasm with variable quantitiy, sometimes red granules present in DQ stain
Amyloid often present
How would you diagnose this (Thyroid FNA)?
Why?
Medullary Thyroid Carcinoma
Plasmacytoid appearance, round eccentrically placed nucleus, granlar cytoplasm
How would you diagnose this (Thyroid FNA)?
Why?
Medullary thyroid carcinoma
Spindle cell pattern with elongated cells with granular cytoplasm
How would you diagnose this? (Thyroid FNA)
Why?
Medullary thyroid carcinoma
We see amyloid in this case, a key clue, look like really thick colloid
What are some characteristics of poorly differentiated thyroid carcinoma in terms of….
Architecture?
N/C ratio?
Nuclear atypia?
Mitosis, apoptosis?
Necrosis?
Insular, solid, or trabecular
High N/C ratio, variable atypia
Both present
Present
How would you diagnose this? (Thyroid FNA)
Why?
Undifferentiated (anaplastic) thyroid carcinoma
Skelatal muscle fragments (indicates invasion of adjacent tissue) with highly pleomorphic cells
How would you diagnose? (Breast FNA)
Characteristics?
Apocrine metaplasia
Distinct borders, centrally located nucleus, prominant nucleolus
How would you diagnose this (Breast FNA)?
Features?
Fibroadenoma
Branching, antler-horn clusters
How would you diagnose this? (Breast FNA)
Features?
Lactation changes
Occasional naked nuclei, loose clusters with nuclear enlargement, a foamy proteinacious background, vaculoated or wispy cytoplasm
How would you diagnose this? (Breast FNA)
Characteristics?
Fat necrosis
Histiocytes with foamy vaculoated cytoplasm and oval nuclei
How would you diagnose? (Breast FNA)
Characteristics?
Papillary neoplasm
Complex branching structures
How would you diagnose this? (Breast FNA)
Characteristics?
Phylloides tumor.
Similar to fibroadenoma but slightly more crowded
How would you diagnose this? (Breast FNA)
What are the characteristic features of this lesion in terms of…
Cellularity?
Nucleus cytoplasm relationship
Nuclear chromicity?
Nuclear size? Shape?
Nucelolus?
Invasive ductal carcinoma
HYPERCELLULAR!!
Sometime you have eccentric nuclei protruding from the cytoplasm “comet cells”
Enlarged nuclei with hyperchromasia and variable size
Nucleolus variable size
How would you diagnose this? (Breast FNA)
What are the characteristic features of this lesion in terms of…
Cellularity?
Nucleus cytoplasm relationship
Nuclear chromicity?
Nuclear size? Shape?
Nucelolus?
Invasive ductal carcinoma
HYPERCELLULAR!!
Sometime you have eccentric nuclei protruding from the cytoplasm “comet cells”
Enlarged nuclei with hyperchromasia and variable size
Nucleolus variable size
How would you diagnose this? (Breast FNA)
What are the characteristic features of this lesion in terms of…
Cellularity?
Architecture?
Cell size?
Cytoplasmic characteristics?
Chromicity and shape of nucleus?
Nucleolus?
Invasive lobular carcinoma
Often HYPOcellular due to stromal fibrosis
Often individual cells with sometimes small linear groups
Cell size is small to medium
Large cytoplasmic vacuoles (signet ring)
Hyperchromatic and kidney bean shaped
Often small
How would you diagnose this? (Breast FNA)
What are the characteristic features of this lesion in terms of…
Cellularity?
Architecture?
Cell size?
Cytoplasmic characteristics?
Chromicity and shape of nucleus?
Nucleolus?
Invasive lobular carcinoma
Often HYPOcellular due to stromal fibrosis
Often individual cells with sometimes small linear groups
Cell size is small to medium
Large cytoplasmic vacuoles (signet ring)
Hyperchromatic and kidney bean shaped
Often small
How would you diagnose this? (Breast FNA)
Why?
Mucinous carcinoma
Tightly cohesive clusters in a mucinous background
How would you diagnose this? (Breast FNA)
Typical characterisicts of lesion in terms of…
Cellularity?
Architecture?
Nuclear chromicity?
Chromatin characteristics?
An interesting feature?
HYPERCELLULAR
Nests of cohesive small cells
Hyperchromatic
Granular chromatin
Round globules within the nests stain red/purple (DQ), green (pap)
How would you diagnose this? (Salivary gland)
Describe?
Normal salivary gland
Aggregated in grape-like bunches with round nuclei and abundant vaculoated cytoplasm
How would you diagnose this cystic lesion? (Salivary gland)
Describe?
Degenerated and anucleate squamous cells with minimal atypia
How would you diagnose this cystic lesion? (Salivary gland)
Describe?
Mucus containing cyst
Histiocytes and magenta colored extracellular mucin
How would you diagnose? (Salivary gland)
Features of this lesion?
Pleomorphic adenoma
A mixture of epithelial and myoepithelial cells with chrondomyxoid matrix (pale-blue on pap, fluffy and magenta on DQ)
How would you diagnose? (Salivary gland)
Features of this lesion?
Pleomorphic adenoma
A mixture of epithelial and myoepithelial cells with chrondomyxoid matrix (pale-blue on pap, fluffy and magenta on DQ)
How would you diagnose? (Salivary gland)
Features of this lesion?
Myoepithelial rich neoplasm (myoepithelioma)
Myoepithelial and epithelial cells
How would you diagnose? (salivary gland)
Features
Basal cell adenoma, membranous type
Spheres of matrix material with a thick ribbon of matrix material seperating the cell groups
How would you diagnose? (salivary gland)
Features
Warthin tumor
Lymphocytes, oncocytic cells, and granular debris
How would you diagnose? (salivary gland)
Features
Oncocytoma
Cohesive clusters of cells with central round nuclei and abundant granular cytoplasm
How would you diagnose? (salivary gland)
Features
Low-grade mucoepidermoid carcinoma
Mucus cells (predominate), intermediate cells, epidermoid cells, extracellular mucin
(Epidermoid cells and cytologic malignancy common in the HIGH GRADE TUMORS)
How would you diagnose? (salivary gland)
Features
Low-grade mucoepidermoid carcinoma
Mucus cells (predominate), intermediate cells, epidermoid cells, extracellular mucin
(Epidermoid cells and cytologic malignancy common in the HIGH GRADE TUMORS)
How would you diagnose? (salivary gland)
Features
Low-grade mucoepidermoid carcinoma
Epidermoid cells and cytologic malignancy
How would you diagnose? (salivary gland)
Features
Cellularity?
Cell shape?
Cytoplasm features? 2
Acinic cell carcinoma
CELLULAR
Polygonal cells
Abdundant vacuolated cytoplasm with PAS positive diastase resistant zymogen granules
How would you diagnose? (salivary gland)
Features
Adenoid cystic carcinoma
Acellular hyaline matrix globules (see attached picture)
Basoloid cells
How would you diagnose? (salivary gland)
Features
Adenoid cystic carcinoma
Acellular hyaline matrix globules (see attached picture)
Basoloid cells
How would you diagnose? (salivary gland)
Features
High grade carcinoma (salivary duct carcinoma)
Malignant cytology with pleomorphic cells, necrosis, primninant nucleoli
How would you diagnose? (salivary gland)
Features
Aspirate cellularity?
Cell population?
Basement membrane?
Epithelial-Myoepithelial carcinoma
CELLULAR ASPIRATE
Biphasic cell population with large and clear myoepithelial cells and small dark ductal cells
Basement membrane material
What does this represent in the context of uriunary cytology?
Normal voided urine
We can see the squamous cell (contamination) with the oval/pyradmidal urothelial cells (intermediate type)
What does this represent in the context of uriunary cytology?
These are cytoplasmic inclusions (Melamed-Wolinska bodies). Degenerating urothelial cells with round eosinophillic inclusions
What does this represent in the context of uriunary cytology?
Features?
Umbrella cells. Notice the low N/C ratio and multi-nucleation (can also have vacuolated cytoplasm). This is common in umbrella cells. The nuclei can also look very atypical, but the important thing is the low N/C ratio.
What does this represent in the context of uriunary cytology?
In what type of specimen are they common?
Basal urothelial cells
Catheterized specimen
What does this represent in the context of uriunary cytology?
What type of specimen would you expect this in?
A close-up of basal urothothelial cells, notice the round, regular nuclear contours
Catheterized specimen
What does this represent in the context of uriunary cytology?
Umbrella cells, notice the abnormal nuclei and vaculoated cytoplasm but it maintains a low N/C ratio
What does this represent in the context of uriunary cytology?
This is an ileal conduit specimen. Obtained when a small portion of ileum is resected and converted into a bladder post-cystectomy. Columnar cells will goblet cells.
What does this represent in the context of uriunary cytology?
What is this?
Cystitis glandularis, hyperchromatic columnar cells and goblet cells. A reactive metaplasia to goblet cells and columbar cells.
What does this represent in the context of uriunary cytology?
What is one condition this can be seen in?
This is a granuloma. Note that this can be seen in patients with prior BCG therapy.
What does this represent in the context of uriunary cytology?
Polyomavirus infection.
You can see the enlarged round nuclei with the glassy, homogeneous inclusion
What does this represent in the context of uriunary cytology?
Polyomavirus infection.
You can see the enlarged round nuclei with the glassy, homogeneous inclusion
What does this represent in the context of uriunary cytology?
Polyomavirus infection.
You can see the enlarged round nuclei with the glassy, homogeneous inclusion
What does this represent in the context of uriunary cytology?
Umbrella cells, notice the abnormal nuclei and vaculoated cytoplasm but it maintains a low N/C ratio
What does this represent in the context of uriunary cytology?
Features?
Reactive urothelial cells,
Coarsely vaculoated cytoplasm, enlarged nuclei, sometimes prominant nucleoli
What does this represent in the context of uriunary cytology?
Benign stone atypia
As you can see, distinguising this from urothelial carcinoma (even high-grade) would be very difficult.
Hyperchromatic and angulated nuclei.
What does this represent in the context of uriunary cytology?
Low grade urothelial carcinoma.
Increased N/C ratio and irregular nuclear outlines. Note that these features are not specific, and can be seen in other reacitive conditions, especially bladder stone atypia.
What does this represent in the context of uriunary cytology?
This is a picture contrasting low grade with a cathetarized specimen. The top one is the catheterized specimen, that has smooth contours and a more orderly arrangement. This is in contrast to the low grade lesion with irregular edges.
What does this represent in the context of urinary cytology?
High-grade urothelial carcinoma
High N/C ratio, We have high N/C ratio, course chromatin. Good for high-grade.
What does this represent in the context of urinary cytology?
High-grade urothelial carcinoma
High N/C ratio, We have high N/C ratio, course chromatinm, and some prominant nucleoli. Good for high-grade. Note that the N/C ratio is increased but not uniformly high in all these cells, making it tricky.
What does this represent in the context of urinary cytology?
Urothelial carcinoma with squamous differentiation
What does this represent in the context of urinary cytology?
This is urothelial carcinoma with adenocarcinoma differentiation
What does this represent in the context of urinary cytology?
Prostatic carcinoma, abundant cytoplasm but prominant nucleoli
What does this represent in the context of urinary cytology?
Small cell carcinoma
What does this represent in the context of esophageal brusings?
Candida infection
You can see both the ovoid yeast forms and pseudohyphae
What does this represent in the context of esophageal brusings?
Herpes infection, note the multi-nucleation, nuclear molding, and ground-glass chromatin pattern.
What does this represent in the context of esophageal brusings?
Barrett’s metaplasia. You can see the large cytoplasmic vacuole expanding the apical portion of the cytoplasm as well as displacing the nucleus.
What does this represent in the context of esophageal brusings?
This is low-grade dysplasia in the context of Barret’s. You can see the goblet cell and the start of stratification.
What does this represent in the context of esophageal brusings?
High grade dysplasia in the context of barrets metaplasia.
What does this represent in the context of esophageal brusings?
Esophageal adenocarcinoma, you can see the chromatin clumping, prominant nucleoli, tumor diathesis, etc…
What does this represent in the context of esophageal brusings?
Squamous cell carcinoma
We can see the keratinized cells with abnormal chromatin distribution with necrotic cells in the background. Note the long, spindled cells as well.
What does this represent in the context of esophageal brushings?
Poorly differentiated SCC. Notice the scant cytoplasm, markedly abnormal chromatin distribution with clumped chromatin and prom nucleoli.
What does this represent in the context of esophageal brushings?
What could you stain this with?
Leiomyoma
Desmin
What does this represent in the context of gastric brushings?
H. pylori
S-shaped basophillic rods entrapped in mucus
What does this represent in the context of gastric brushings?
Signet ring carcinoma, note the large vacuoles with hyperchromatic and angulated nuclei
What does this represent in the context of duodenal brushings?
Well differentiated endocrine tumor (carcinoid)
These cells are dyscohesive with scant to absent cytoplasm and finely specled chromatin.
What does this represent in the context of duodenal brushings?
Well differentiated NE tumor. Note the bland, round nuclei and focal rosette formation. Scant cytoplasm is present.
What does this represent in the context of duodenal brushings?
Well differentiated NE tumor. Note the bland, round nuclei with plasmacytoid morphology, and moderate cytoplasm.
What does this represent in the context of gastric brushings?
DLBCL, we have scatered cells with little to no cytoplasm, vesicular chromatin, and necrotic debris.
What does this represent in the context of gastric brushings?
MALT lymphome, these cells are smaller then the DLBCL cells and more monotonous. Can easily be mistaken for chronic inflammation.
What does this represent in the context of gastric brushings?
Gastrointestinal stromal tumor, bland chromatin and incomspicious nucleoli.
What does this represent in the context of gastric brushings?
Crytosporidia.
You can see these very small round basophillic bodies.
What does this represent in the context of ampullary brushings?
An ampullary adenoma.
Note the crowded group of glandular cells with increased N/C ratios, they still maintain general order though, consistent with an adenoma
What does this represent in the context of colonic brushings?
Colon adenoma
The cells are stratified and have increased N/C ratio but still have an orderly arrangement
What does this represent in the context of anal brushings?
This is HSIL, the anal pap version. Looks just like the cervical version.
What does this represent in the context of liver cytology?
These are normal hapatocytes. You can see the yellow lipofusin, the “wear and tear” pigment that can be common. You also have granular cytoplasm, 1-2 nuclei, and prominant nucleoli.
What does this represent in the context of liver cytology?
Steatosis
You can see these fatty cells intermixed with the hepatocytes.
What does this represent in the context of liver cytology?
This is bile pigment, it is dark green-black and should not be present in normal hepatocytes. This patient had cirrosis.
What does this represent in the context of liver cytology?
Liver cell adenoma
Mild nuclear atypia with a slight variation in size. HCC should have greater cellular atypia.
What does this represent in the context of liver cytology?
Angiomyolipoma
You can see the epithelial cells, and fat cells (maybe vessels too??)
Note the extramedullary hematopoesis in the form of a megakaryocyte (arrow)
What does this represent in the context of liver cytology?
Hepatocellular carcinoma
A hypercellular aspirate with vessels coursing through these hepatocytes (often “wrap” around hepatocytes. The N/C ratio is increased.
What does this represent in the context of liver cytology?
HCC
You can see the clumps of hepatocytes with bile pigment (should not be present in normal hepatocytes), increased N/C ratio, and vessels wrapping the clusters
What does this represent in the context of liver cytology?
HCC
Thicken trabeculae of neoplastic cells with high N/C ratio, these are surrounded by endothelial cells
What does this represent in the context of liver cytology?
HCC
This specimen is hypercellular (just take my word for it), the cells have an increased N/C ratio and several naked nuclei are present.
What does this represent in the context of liver cytology?
This represents fibrolamellar carcinoma. We have large cells with lots of cytoplasm, large nuclei with prominant nucleoli, and dense bands of fibrosis seperating these cells.
What does this represent in the context of liver cytology?
Cholangiocarcinoma
Tightly cohesive clusters, crowded sheets, and/or isolated cells.
Nuclear enlargement and variation in size and shape
Scant cytoplasm
What does this represent in the context of liver cytology?
Cholangiocarcinoma
Hapahazrdly arranged cells with crowding, hyperchromasia, and increased N/C ratio
What does this represent in the context of liver cytology?
Metastatic colon cancer, elongated cells with prominant nucleoli. Often has necrosis in the background.
What does this represent in the context of liver cytology?
Metastatic NE tumor (carcinoid)
Hyperchromatic cells with salt and pepper chromatin, they are monotanous with scant cytoplasm.
What does this represent in the context of liver cytology?
Metastatic small cell carcinoma
Scant cytoplasm, molding
What does this represent in the context of liver cytology?
Metastatic melanoma
Notice the finely granular melatin pigment that tends to be more packed inside the cells then bile pigment
What does this represent in the context of liver cytology?
Metastatic GIST. Spindle cells (minimal atypia in this case)
What does this represent in the context of pancreas cytology?
These are normal acinar cells of the pancreas. It has granular cytoplasm and eccintric nuclei.
What does this represent in the context of pancreas cytology?
Normal pancreatic ductal cells
What does this represent in the context of pancreas cytology?
Features?
What stains may be helpful?
Reactive atypia (in chronic pancreatitis)
You can have some enlargement, prominant nucleoli, and nuclear overlap. In some cases, this can be difficult to distinguish from pancreatic adenocarcinoma. It can also mimic a neoplastic process radiographically
p53 and SMAD4 (pancreatice adenocarcinoma will show increased p53 and loss of SMAD4 usually)
What does this represent in the context of pancreas cytology?
Features?
What stains may be helpful?
Pancreatic ductal adenocarcinoma
We have a “drunken honeycomb” appearence with a more haphazard organization and uneven spacing. Anisonucleosis (signifiant nuclear size variation) is another big feature. You can also have nuclear contour irregulaities. Mitoses are acutally uncommon in well-differentiated pancreatic adenocarcinomas, but become more frequent in more poorly differentiated lesions.
p53 and SMAD4 (pancreatice adenocarcinoma will show increased p53 and loss of SMAD4 usually)
What does this represent in the context of pancreas cytology?
Features?
What stains may be helpful?
Pancreatic ductal adenocarcinoma
Drunken honeycomb (overlapping, uneven spacing), anisonucleosis, infrequent mitosis in well-diff and more frequent in moderate and poorly diff,
p53 and SMAD4 (pancreatice adenocarcinoma will show increased p53 and loss of SMAD4 usually)
What does this represent in the context of pancreas cytology?
Features?
What stains may be helpful?
Pancreatic ductal adenocarcinoma
Drunken honeycomb (overlapping, uneven spacing), anisonucleosis, infrequent mitosis in well-diff and more frequent in moderate and poorly diff,
p53 and SMAD4 (pancreatice adenocarcinoma will show increased p53 and loss of SMAD4 usually)
What does this represent in the context of pancreas cytology?
Features?
Adenosquamous carcinoma of the pancreas
A mixed population of neoplastic squamous (sometimes dense, orangophillic cytoplasm) and glandular elements
What does this represent in the context of pancreas cytology?
Features….
Cellularity?
Architecture?
Nuclear features? (3)
Cytoplasmic feature?
Acinar cell carcinoma
A highly cellular specimen with a variety of patterns including loose aggregates and individual cells. The cells have round nulcei with smooth contours and prominant nucleoli. The cytoplasm is granular and variable in amount (scant to abundant)
