Week of September 29, 2008

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