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Cytopathology Challenge: Weekly Cases Review (Sept 29, 2008) - Diagnostic Insights

This comprehensive review details the cytopathology cases from the week of September 29, 2008, featuring a diverse range of patient demographics and pathological findings. Analyze cases including a 24-year-old female with bacterial vaginosis, a 43-year-old male presenting with an FNA of a neck mass, and intriguing urine cytology results in a 57-year-old male. Additional case discussions involve adenocarcinoma in pleural fluid and thyroid FNA interpretations. Perfect for professionals seeking to enhance their diagnostic skills through case-based learning.

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Cytopathology Challenge: Weekly Cases Review (Sept 29, 2008) - Diagnostic Insights

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  1. Cytopathology Challenge Weekly Cases Week of September 29, 2008

  2. 24 year old female. ThinPrep pap • Lactobacillus • Gonorrhea • Trichomonas • Bacterial Vaginosis • Artifact 1

  3. 24 year old female. ThinPrep pap D. Bacterial Vaginosis – coccobacilli cover the squamous cells. Also called “Clue cells” 1

  4. 43 year old male. FNA of neck mass • Nematode worm • Rhabdomyosarcoma • Normal muscle • Squamous cell carcinoma • Colloid 2

  5. 43 year old male. FNA of neck mass C. Normal muscle – strips/chunks of muscle with peripherally placed nuclei and striations 2

  6. 57 year old male. Urine cytology • Reactive urothelial cells • High grade TCC • Low grade TCC • Squamous cell carcinoma • Polyoma virus 3

  7. 57 year old male. Urine cytology E. Polyoma virus – enlarged cell with smudgy intranuclear inclusion. Do not mistake for High grade TCC! 3

  8. 62 year old female. Peritoneal fluid • Positive for tumor - Adenocarcinoma • Reactive mesothelial cells • Atypical • Positive for tumor – Lymphoma • Benign lymphocytic effusion 4

  9. 62 year old female. Pleural fluid • Positive for tumor - Adenocarcinoma • “Cannonball” group of epithelial cells with large nuclei and distinct cell borders. Pleomorphism and irregular nuclear membranes are seen. Patient had history of breast cancer. 4

  10. 53 year old female. Pleural fluid A. Positive for tumor - Adenocarcinoma B. Reactive mesothelial cells C. Atypical D. Positive for tumor – Lymphoma E. Benign lymphocytic effusion 5

  11. 53 year old female. Pleural fluid A.Positive for tumor – Adenocarcinoma Large pleomorphic single cells with secretory vacuoles c/w adenoca. Signet rings forms are noted. Pt also has history of breast cancer. Don’t miss single malignant cells in effusions! 5

  12. 36 year old female. Thyroid FNA • Goiter • Indeterminate • Positive for tumor – papillary thyroid carcinoma • Positive for tumor – follicular carcinoma • Hurthle cell neoplasm 6

  13. 36 year old female. Thyroid FNA B. Indeterminate – multiple microfollicles with no colloid in the background. This is suspicious for a potential follicular neoplasm. On cytology we call this indeterminate because we cannot determine whether this is a follicular adenoma or a follicular carcinoma (for which you need to see either capsular +/or vascular invasion on histo) 6

  14. 60 year old male s/p bilateral lung transplant. BAL • Aspergillus • Candida • PCP • Mucor • Fusarium 7

  15. 60 year old male s/p bilateral lung transplant. BAL • Aspergillus – septated hyphae with 45 degree branching 7

  16. 29 year old female. ThinPrep pap • Reactive • Endocervical cells • ASC-US • LSIL • HSIL 8

  17. 29 year old female. ThinPrep pap D. LSIL – enlarged nuclei with koilocytic change. Also have binucleates 8

  18. 63 year old male. FNA of lung A. Adenocarcinoma B. Squamous cell carcinoma C. Small cell carcinoma D. BAC E. Reactive lymphocytes 9

  19. 63 year old male. FNA of lung C. Small cell carcinoma – note the molding 9

  20. 26 year old female. ThinPrep pap • LSIL • HSIL • Endometrial cells • Squamous cell carcinoma • Tubal metaplasia 10

  21. 26 year old female. ThinPrep pap B. HSIL 10

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