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

• 
• 
• 
• 
• 
• 
• 
• 

Resident Questions

• Diagnosis?

• Small Cell Carcinoma
  • 12-18% of all lung cancers
  • Age range 32-79 years
  • Males > Females
  • Association with smoking

• Are these tumors resectable?

Most are metastatic at diagnosis, therefore not resectable.

• 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)

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