Difference between revisions of "Cytologically Yours: CoW: 20131216"

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===Cytology===
 
===Cytology===
 
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CytologicallyYoursCoW20131216Cytology1.jpg|4x magnification of a 4R lymph node. Groups of cohesive epithelial appearing cells can be seen on low power. Lymphoid tissue is not easily identified.
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CytologicallyYoursCoW20131216Cytology1.jpg|10x magnification of pleural fluid(ThinPrep). Groups of cohesive epithelial appearing cells are seen on low power.
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CytologicallyYoursCoW20131216Cytology2.jpg|20x magnification of a 4R lymph node. This is a cellular specimen with groups of cells along what appear to be a papillary or papillary-like structure. Single cells are also dispersed in the background. The cells are haphazardly arranged.
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CytologicallyYoursCoW20131216Cytology2.jpg|40x magnification of pleural fluid (ThinPrep). Cluster of atypical cells showing nuclear pleomorphism and scant cytoplasm.
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CytologicallyYoursCoW20131216Cytology3.jpg|40x magnification of a 4R lymph node. On higher power, the nuclei appear mildly atypical and the cytoplasm is delicate and finely vacuolated. The nuclear contours are somewhat irregular.
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CytologicallyYoursCoW20131216Cytology3.jpg|40x magnification of pleural fluid (ThinPrep). Chromatin is irregular and clumped with salt and pepper appearance.
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CytologicallyYoursCoW20131216Cytology4.jpg|Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical.  
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CytologicallyYoursCoW20131216Cytology4.jpg|40x magnification of pleural fluid (ThinPrep). Some nuclear molding can be appreciated.
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CytologicallyYoursCoW20131216Cytology5.jpg|Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical.  
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CytologicallyYoursCoW20131216Cytology5.jpg|Cell block of pleural fluid. Group of malignant cells showing nuclear molding, scant cytoplasm, and salt and pepper chromatin.  
  
  

Revision as of 21:56, 14 January 2014

Clinical Summary

The patient is an 66 year old white male with a history of smoking, COPD, and diabetes. The patient presented with increased shortness of breath.

Past Medical History

  • Diabetes
  • COPD
  • Squamous cell carcinoma of skin

Past Surgical History

  • Excision of squamous cell carcinoma
  • Removal of adenomatous polyp of sigmoid colon


Clinical Plan

The differential diagnosis includes worsening of COPD. CT imaging of chest is performed.

Radiology

  • CT Chest shows hilar lung mass and multiple mediastinal lymph nodes showing increased uptake on PET scan.

Pathology

Cytology

  • 10x magnification of pleural fluid(ThinPrep). Groups of cohesive epithelial appearing cells are seen on low power.

  • 40x magnification of pleural fluid (ThinPrep). Cluster of atypical cells showing nuclear pleomorphism and scant cytoplasm.

  • 40x magnification of pleural fluid (ThinPrep). Chromatin is irregular and clumped with salt and pepper appearance.

  • 40x magnification of pleural fluid (ThinPrep). Some nuclear molding can be appreciated.

  • Cell block of pleural fluid. Group of malignant cells showing nuclear molding, scant cytoplasm, and salt and pepper chromatin.

Immunohistochemistry

  • CD56 on pleural fluid shows positive cytoplasmic staining.

  • Synaptophysin on pleural fluid shows positive cytoplasmic staining.

Resident Questions



Click here to toggle the diagnosis and case discussion.

Final Diagnosis

Cytology

  • Rapid diagnosis: Non-small cell carcinoma.
  • Final diagnosis: Renal cell carcinoma.


Case Discussion

This is a classic case of metastatic renal cell carcinoma.

Cases of the Week
Unknowns
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