Presentation material is for education purposes only. All rights reserved URMC Radiology Page 1 of 98

Size: px

Start display at page:

Lee Chambers
5 years ago
Views:

Radiology / Pathology Conference February 2011 Brooke Koltz, Cytopathology Resident

Presentation material is for education purposes only.

Case 1 Lung, RUL, CT-guided FNA: Diff-Quik Presentation material is stain for

Lung, RUL, CT-guided FNA: Diff-Quik stain Presentation material is for

Lung, RUL, CT-guided FNA: Papanicolaou stain Presentation material is for

Lung, RUL, CT-guided FNA: Cell Block, hematoxylin & eosin stain Presentation material

Presentation material is for education purposes

19 Lung, RUL, CT-guided fine needle aspiration: Malignant tumor cells present derived from adenocarcinoma, favor colonic primary. Cell block and cytologic preparations examined. The tumor cells are positive for CDX-2 and focal positive for CK 20, negative for CK 7 and TTF-1. The results support the diagnosis of metastatic adenocarcinoma, favor colonic primary. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 19 of 98

Lung, right upper lobe, wedge resection: H & E stain Presentation material is

22 Lung, right upper lobe, wedge resection: Adenocarcinoma, moderately differentiated, morphologically consistent with a metastatic carcinoma of known history of rectal carcinoma. Lymph node, level 4 and level 10, biopsy: Chronic lymphocytic leukemia. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 22 of 98

Rectum, low anterior resection: H & E Presentation material is for

25 Rectum, low anterior resection: Adenocarcinoma, status post radiation therapy. K-RAS Gene Rearrangement: K-RAS Gene: Normal, no mutations in codon 12 and 13 were seen. Lymph node, pericolic: Metastatic adenocarcinoma identified in two of fifty one lymph nodes (2/51). Effacement of multiple lymph nodes by monomorphic lymphoid population consistent with previous known diagnosis of chronic lymphocytic leukemia. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 25 of 98

26 Metastatic Adenocarcinoma Colonic Primary! Metastatic carcinoma to the lung more common than primary lung CA! Most common metastatic neoplasms are adenocarcinomas from breast, kidney and colon! Cytomorphology of columnar cells and elongated nuclei forming a palisade-like arrangement or clusters of signet ring- type cells! Immunohistochemical stains:! CDX-2, CK 20 positive! CK 7 negative! Histochemical mucin stain + Presentation material is for education purposes only. All rights reserved URMC Radiology Page 26 of 98

Lung, RUL, CT-guided FNA: Diff-Quik stain Case 2 Presentation material is for

37 Lung, right upper lobe, CT-guided fine needle aspiration: Malignant tumor cells present derived from adenocarcinoma. Cell block and cytologic preparations examined. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 37 of 98

Lung, right upper lobe, biopsy: H & E stain Presentation material is for

41 Adenocarcinoma of Lung! Adenocarcinoma: most common lung carcinoma in females and non-smokers! Positive immunostaining for CK-7, TTF-1, Napsin A, and negative for CK-20! Positive intracellular histochemical staining for mucin! Broad classification is non-small cell carcinoma (80%) versus small cell carcinoma (20%) Presentation material is for education purposes only. All rights reserved URMC Radiology Page 41 of 98

Case 3 Rib, right posterior, CT-guided FNA: Diff-Quik Presentation material is

Rib, right posterior, CT-guided FNA: Diff-Quik stain Presentation material is

Rib, right posterior, CT-guided FNA: Papanicolaou Presentation material is for

Rib, right posterior, CT-guided FNA: Cell Block, hematoxylin & eosin stain Presentation

52 Rib, right posterior, CT-guided fine needle aspiration: Malignant tumor cells with focal spindle cells present derived from squamous cell carcinoma. Cell block and cytologic preparations examined. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 52 of 98

Lung, right upper lobe, lobectomy: H & E stain Presentation material is for

55 Lung, right upper lobe, lobectomy: Pleomorphic carcinoma with extensive necrosis. The tumor consists of typical areas of squamous cell carcinoma and adenocarcinoma along with prominent spindle cell areas, consistent with a diagnosis of pleomorphic carcinoma. No metastatic carcinoma identified - 0/33 lymph nodes. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 55 of 98

56 Pleomorphic Carcinoma of Lung! Rare, <1% of all lung carcinomas! Male predominance! Smokers! Subtype of sarcomatoid CA of lung! Dual malignant epithelial cell component and sarcomatoid spindle cell elements! Prognosis is poor! Early relapse of disease common Presentation material is for education purposes only. All rights reserved URMC Radiology Page 56 of 98

Case 4 Pleural based mass, CT-guided FNA: Diff-Quik Presentation material is stain

Pleural based mass, CT-guided FNA: Diff-Quik stain Presentation material is for

Pleural based mass, CT-guided FNA: Papanicolaou stain Presentation material is

82 Pleural based mass, CT-guided fine needle aspiration: Malignant tumor cells present derived from adenocarcinoma. Cell block and cytologic preparations examined. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 82 of 98

Pleura, base mass, biopsy: H & E stain Presentation material is for

86 Pleura, base mass, biopsy: Adenocarcinoma, most consistent with origin from lung. Comment: Immunohistochemical stain for Napsin A is strongly +.. TTF-1 and CK 7 are positive. CK 20, ER and PR, Her2, BRST2, mammoglobin and CDX-2 are negative. The staining pattern, combined with the morphology and in comparison with the patientõs s prior breast carcinoma, is most consistent with an origin from lung. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 86 of 98

87 Adenocarcinoma of Lung! More common in women then men.! Tend to be peripheral in location.! Metastatic carcinoma to the lung must be ruled out.! Immunohistochemical stains TTF-1 and Napsin A, Cytokeratin 7 + Cytokeratin 20 -! Clinical history Presentation material is for education purposes only. All rights reserved URMC Radiology Page 87 of 98

Case 5 Mediastinum, anterior, CT-guided FNA: Diff-Quik stain Presentation material

Mediastinum, anterior, CT-guided FNA: Presentation material is for education

92 Mediastinum, anterior, CT-guided fine needle aspiration: Atypical lymphocytes present. Please see separate flow cytometry and concurrent core biopsy report. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 92 of 98

Soft tissue, anterior mediastinum, Presentation material is for education purposes only.

95 Soft tissue, anterior mediastinum, core needle biopsy: Thymoma. This diagnosis was rendered in conjunction with the flow cytometry specimen. Sections show core needle biopsies of soft tissue with diffuse sheets of small round blue cells with scant cytoplasm that are + for TdT, CD3, CD4 and CD8. Pancytokeratin stain is strongly +. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 95 of 98

96 Soft tissue, anterior mediastinum, fine needle aspiration (flow cytometry): Flow cytometry findings most consistent with thymoma. Cytospin shows numerous small lymphocytes as well as larger forms with high N/C ratios and immature chromatin. No monoclonal B-cell population is detected. Events in the small lymphocyte gate co-express CD4 and CD9, consistent with thymic origin, with maturational loss of CD4 and CD8 in two separate populations. By side scatter versus CD45, half of events are + for cytoplasmic TdT and CD3 and negative for CD34. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 96 of 98

97 Thymoma! Rarely encountered neoplasm located in anterior mediastinum.! Tumor stage is most significant prognostic factor.! Occurs in all age groups peaks in 6 th decade.! No sex predilection.! 10-80% of patients have symptoms of myasthenia gravis.! Cytologically dual populations of epithelial cells and lymphocytes in various proportions.! Differential diagnosis includes lymphoepithelioma-like CA, carcinoid tumor, precursor T-lymphoblastic lymphoma, HodgkinÕs s lymphoma, thymic CA and reactive lymphoid hyperplasia.! Immunohistochemical Stains:! Epithelial cells Ð Cytokeratin +! CD8, CD3 and CD4 +! Predominance of cortical component: TdT + Presentation material is for education purposes only. All rights reserved URMC Radiology Page 97 of 98

Radiology Pathology Conference

Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights