Cytologically Yours: CoW: 20131216
Contents
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; although, occasional nucleoli are also seen.
40x magnification of pleural fluid (ThinPrep). Some nuclear molding can be appreciated and a mitotic figure is present.
Cell block of pleural fluid. Group of malignant cells showing nuclear molding, scant cytoplasm, and salt and pepper chromatin. Nucleoli are also seen.
Immunohistochemistry
CD56 on pleural fluid shows positive cytoplasmic staining.
Synaptophysin on pleural fluid shows positive cytoplasmic staining.
Other immunostains performed
- BerEp4 Positive
- Moc31 Faintly positive
- Calretinin Negative
- TTF1 Negative
- Chromogranin Positive
- Synaptophysin Positive
- CD56 Positive
- Napsin A Negative
Resident Questions
Final Diagnosis
Cytology
- Small cell carcinoma
Case Discussion
This is a classic case of metastatic small cell carcinoma in pleural fluid.