Case 1 57 year female Routine Pap smear
Diagnosis? 1. Atypical glandular cells of unknown significance (AGUS) 2. Endocervical AIS 3. Endocervical adenocarcinoma 4. Endometrial adenocarcinoma 5. Adenocarcinoma NOS
Atypical glandular cells No diathesis
Adenocarcinoma NOS? Extra-uterine
Serous papillary ovarian carcinoma
Psammoma body in cervical smear Adenoca ovary with stromal invasion Psammoma body in cervical smear Serous cystadenofibroma ovary Cytojournal 2008
Extrauterine adenocarcinomas Usually from ovary, rarely from tube Exfoliated ca cells from ovarian tumor or malig ascites may pass through tube, endometrial cavity and os and reach the cervical sample No diathesis, unless they are metastatic to vagina or cervix Adenoca with psammoma bodies is highly suggestive of ovarian ca Direct extension from rectal or bladder ca Lymphatic or hematogenous spread of GIT ca, breast ca, ovary
38 year old female with neck swelling On examination: 3.5 cm, firm left thyroid nodule
Case 3 40 year old female White discharge PV - 3 months Irregular bleeding PV - 3 months
Cytologic features Spindle and plump cells, some with fibrillary cytoplasmic processes, no atypia Atypical squamous cells Smear background clean, no diathesis
Langerhan cell histiocytosis Occasionally involves the thyroid as part of multi-organ disease Patient presents with hypothyroid or euthyroid, diffuse/ nodular goiter Accompanying symptoms relate to other organ involvement
Case 5 62 year female Foul smelling discharge PV Previous year Pap smear within normal limits
Diagnosis? HSIL Keratinizing SCC Atrophic pattern Leiomyoma
Papillary lesion with oncocytes Oncocytic focus in Papillary ca Papillary Hurthle cell tumor? variant of Papillary carcinoma: Oncocytic (oxyphilic) variant Tall cell variant? Warthin tumor-like variant (lymphoplasmacytic cells in papillary cores and ants at a picnic appearance)
Oncocytic variant of PC Papillary & follicular structures populated by oncocytes. Abundant, coarsely granular cytoplasm Nuclear features of PC Macronucleoli absent, (distinguishing feature from papillary HCT). Local invasion common, so more extensive surgery than classic PC. Tall cell variant: oxyphilic cells twice as tall as they are wide, frequent nuclear grooves and inclusions. septated, or vacuolated cytoplasm, lymphocytes often present.
Case 3 40 year old female White discharge PV - 3 months Irregular bleeding PV - 3 months
TBS atlas-hsil
Cytologic features Spindle and plump cells, some with fibrillary cytoplasmic processes, no atypia Atypical squamous cells Smear background clean, no diathesis
Questions/ clarifications?
On per speculum examination there was a 4x3 cm polypoid ulcerated mass in the cervix and the os could not be visualized. The smear was a scrape smear taken from the mass
Cytologic diagnosis given ASCUS with spindle cell lesion, possibly a leiomyomatous polyp Advised excision for histological examination
Leiomyomatous cervical polyp with overlying epithelium showing reparative atypia
6 year old male Soft left lobe thyroid swelling Generalized weakness and malaise
Medium to large cells with low to medium N:C ratio Eccentric nuclei, nuclear indentations in some Dendrite-like cytoplasmic processes Admixture with neutrophils, eosinophils, lymphocytes No thyroid follicular cells? Langerhans cell histiocytosis No additional smears for immunophenotyping
S100
Langerhan cell histiocytosis Occasionally involves the thyroid as part of multi-organ disease Patient presents with hypothyroid or euthyroid, diffuse/ nodular goiter Accompanying symptoms relate to other organ involvement
Cytological smears show a polymorphous cell population composed of varying proportions of Langerhans cells (LCs), eosinophils, lymphocytes, plasma cells and MNGs. LCs show nuclear indentations or grooves and dendrite-like cytoplasmic processes
LCs may manifest plump nuclei and increased mitotic activity - may be mistaken cytologically for lymphoma.
Differential diagnosis includes benign infective or non-infective granulomatous lesions. Examination of a quick-stained bedside smear can raise the possibility of LCH and allow additional smears to be wetfixed in ethanol for S100 staining and other lymphoid markers.
Case 5 62 year female Foul smelling discharge PV Previous year Pap smear within normal limits
Diagnosis? HSIL Keratinizing SCC Atrophic pattern Leiomyoma
TBS atlas-atrophy Diagnosis? Atrophy mimicking spindle cell lesion
Case 6 32 years female Left breast lump 3 years O/E: 5 cm, firm, mobile lump in the central and adjacent medial quadrants of left breast, partly retro-areolar
Diagnosis given Spindle cell mesenchymal malignancy; possibilities of malignant phyllodes tumor and metaplastic carcinoma are suggested
Final diagnosis Malignant phyllodes tumor
Spindle cell lesions of breast Breast lesions with a significant spindle cell or mesenchymal component are rarely encountered in FNA and constitute a heterogeneous group that may pose a diagnostic dilemma. Reactive conditions: diabetic mastopathy, granulation tissue, granulomatous lesions Benign neoplastic conditions: mammary hamartoma, dermatofibroma, fibromatosis, angiolipomas Low grade malignant neoplastic lesions, low grade phyllodes tumors High grade malignant neoplastic lesions: metaplastic carcinoma, leiomyosarcoma, malignant fibrous histiocytoma, metastatic melanoma. Diabetic mastopathy: dense keloid-like fibrosis, lymphocytic lobulitis and ductitis, lymphocytic perivascular inflammation, epithelioid-like fibroblasts
Fibromatoses
Leiomyosarcoma breast
Metaplastic Ca
Metaplastic Ca
Metastatic sarcoma from bone
Dual cell population with benign phyllodes fragments along with markedly atypical and mitotic spindle cells: suggestive of malignant PT Dual cell population (or more than two types of cells) with atypia of spindle and epithelioid cells: suggestive of metaplastic carcinoma Malignant squamous cells and chondroid stroma: suggestive of metaplastic ca Spindle cell sarcomas: usually one type of cell Pleomorphic sarcomas: varied cell morphology, polymorphism of cells
Stop cutting trees this is serious!