View source for Cytologically Yours: Unknowns: 201310: Case 2

==Clinical History==
55 year old male with a right upper lobe lung mass and mediastinal adenopathy.
The patient is a smoker.

==Cytology==
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===Resident Questions===
* <spoiler text="Diagnosis?">
*Small Cell Carcinoma
**12-18% of all lung cancers
**Age range 32-79 years
**Males &gt; Females
**Association with smoking 
</spoiler>
* <spoiler text="Are these tumors resectable?">
Most are metastatic at diagnosis, therefore not resectable.
</spoiler>
* <spoiler text="Name 3 markers you could use to confirm the diagnosis."> 
* CD56
* Synaptophysin
* Chromogranin
* Neuron Specific Enolase (NSE)
* Pancytokeratin (dot like staining)
* Thyroid Transcription Factor-1 (TTF-1)
</spoiler>

==Additional Teaching Points==
===Differential Diagnosis===
* Follicular bronchitis
** Polymorphic lymphocytic population
** Follicular centers
** Tingible body macrophages
** Plasma cells
* Reactive bronchial cells
** Round/cuboidal (en face) columnar (on profile)
** Smooth nuclear membranes
** Fine granular chromatin
** No nuclear molding
* Carcinoid
** Cells will be in loosely cohesive groups or in tissue fragments, in cords, nests, ribbons, or acinar pattern
** Cells will be uniform small round with round/oeal smooth nuclear membrane
** Salt and pepper chromatin
** +/- Nucleoli
** No molding
** + Neuroendocrine markers, + Cytokeratin, + CEA
* Large Neuroendocrine Carcinoma
** Isolated cells or loosely cohesive groups
** Variable cell size and cytoplasm
** High N/C
** Round nuclei
** Coarsely granular cytoplasm 
** Frequent nucleoli
** Nuclear molding

{{Cytologically Yours}}

[[Category:Unknowns]]
[[Category:Respiratory]]