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Week of March 30, 2009

Cytopathology Challenge Weekly Cases. Week of March 30, 2009. 17 year old female. Conventional pap Endocervical adenocarcinoma in situ Benign endometrial cells Viral changes consistent with Herpes Alternaria Trichimonas. 1. 17 year old female. Conventional pap

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Week of March 30, 2009

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  1. Cytopathology Challenge Weekly Cases Week of March 30, 2009

  2. 17 year old female. Conventional pap • Endocervical adenocarcinoma in situ • Benign endometrial cells • Viral changes consistent with Herpes • Alternaria • Trichimonas 1

  3. 17 year old female. Conventional pap C. Viral changes consistent with Herpes This picture is slightly out of focus; however, you can still see the molding and margination of the nuclei c/w herpes 1

  4. 69 year old male. FNA of Lung • Granuloma • Non-small cell carcinoma • Small cell carcinoma • Reactive bronchial cells • Lymphoma 2

  5. 69 year old male. FNA of Lung B.Non-small cell carcinoma – The cluster is cohesive with large pleomorphic cells. The cells are overlapping and disorganized. 2

  6. 57 year old male. Urine cytology A. Polyoma virus B. Reactive urothelial cells C. High grade TCC D. Metastatic prostate carcinoma E. This picture is horrible…I can’t tell. 3

  7. 57 year old male. Urine cytology C.High grade TCC -- Though this picture is horrible (much like the pictures on the test), you can tell this is high grade TCC. The cells are enlarged (compared to the polys) with irregular nuclear membranes, eccentric nuclei and dark/irregularly distributed chromatin. 3

  8. 67 year old male. History of prostate carcinoma and squamous cell carcinoma of the lung. Now presents with bone pain. FNA of bone lesion • Positive for tumor - Adenocarcinoma • Positive for tumor - SCC • Plasma cell neoplasm • Positive for tumor – Lymphoma • Positive for tumor - melanoma 4 Pap Diff Quick

  9. 67 year old male. History of prostate carcinoma and squamous cell carcinoma of the lung. Now presents with bone pain. FNA of bone lesion • Positive for tumor– Adenocarcinoma • The cells are cohesive with vague formation of acinar structures (seen in DQ). The monomorphic appearance of the cells along with the prominent nuclei favors prostate adenocarcinoma. Melanoma is in the differential; however, melanoma cells are usually more discohesive. Immunostains can always be done to help with the diagnosis. 4 Pap Diff Quick

  10. 34 year old female. Thin Prep Pap A. LSIL B. Squamous metaplasia C. Benign endocervical cells D. HSIL E. AIS 5

  11. 34 year old female. Thin Prep Pap D. HSIL 5

  12. 60 year old male. BAL A. Aspergillus B. Blastomycosis C. PCP D. A and B E. A and C 6

  13. 60 year old male. BAL E. A and C – This is a case of Aspergillus and PCP together. 6

  14. 51year old female with extensive bilateral lung infiltrates. A BAL shows numerous amorphous globules as seen here. What stain should be ordered to confirm the diagnosis? • Silver stain (GMS) • PAS • Iron stain • Oil Red O • Reticulin 7 PAP

  15. 51year old female with extensive bilateral lung infiltrates. A BAL shows numerous amorphous globules as seen here. What stain should be ordered to confirm the diagnosis? B. PAS – PAS will confirm the diagnosis of Pulmonary Alveolar Proteinosis. 7 Surgical PAS

  16. 41 year old female with newly developed breast mass. Breast FNA A. Positive for breast carcinoma B. Phyllodes tumor C. Fibroadenoma D. Consistent with breast cyst E. Reactive ductal cells 8

  17. 41 year old female with newly developed breast mass. Breast FNA C. Fibroadenoma 8

  18. 29 year old female. ThinPrep pap • Reactive • Squamous metaplasia • ASC-US • LSIL • HSIL 9

  19. 29 year old female. ThinPrep pap D. LSIL 9

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