Cytopathology Cytopathology Conference: A Few Conference: A Few Interesting CasesInteresting Cases

November 17, 2005November 17, 2005

Case #4Case #4

Cervicovaginal thinprep from a Cervicovaginal thinprep from a 55-year-old female.55-year-old female.

Diagnosis?Diagnosis?

Endocervical Endocervical AdenocarcinomaAdenocarcinoma

in Situ (AIS)in Situ (AIS)

Adenocarcinoma in SituAdenocarcinoma in Situ GroupsGroups

Very crowdedVery crowded

Stratified stripsStratified strips

RosettesRosettes

Conventional slides: “feathering”Conventional slides: “feathering”

Liquid-based slides: “knucklesLiquid-based slides: “knuckles””

Adenocarcinoma in SituAdenocarcinoma in Situ NucleiNuclei

High N/C ratioHigh N/C ratio

Oval to elongated or regularOval to elongated or regular

Marked hyperchromasiaMarked hyperchromasia

Coarse chromatinCoarse chromatin

Nucleoli typically inconspicuousNucleoli typically inconspicuous

Adenocarcinoma in SituAdenocarcinoma in Situ

No diathesisNo diathesis

Frequently associated with Frequently associated with squamous lesionssquamous lesions

Case #4Case #4

64-year-old female with 64-year-old female with a history of a left breast a history of a left breast mass.mass.

Diagnosis?Diagnosis?

Mucinous Neoplasm or Mucinous Neoplasm or LesionLesion

Suspicious for mucinous carcinomaSuspicious for mucinous carcinoma Differential includes mucocele-like lesionDifferential includes mucocele-like lesion

Mucocele with an associated Intraductal Papilloma

Papilloma: Benign Features

• Well developed fibrovascular core – Arborizing fronds

– Club-like fronds can have adenomatous component

• Two Cell types– Myoepithelial cell variably distinctive but

always present

Differential

• Colloid Carcinoma– Irregular groups of cells

– More single intact cells

– Abnormal nuclei

– Older patients

Comparison: Colloid Carcinoma

Comparison: Colloid Carcinoma

Colloid Carcinoma

Case #5Case #5

55-year-old male with an FNA 55-year-old male with an FNA from a right inguinal lymph from a right inguinal lymph node.node.

Diagnosis?Diagnosis?

High-grade mostly necrotic High-grade mostly necrotic malignant neoplasmmalignant neoplasm

ImmunohistochemistryImmunohistochemistry

Vimentin: Vimentin: PositivePositive

Pan-Keratin, CK7, CK20, LCA, Pan-Keratin, CK7, CK20, LCA, CD20, CD3 and c-kit: negative CD20, CD3 and c-kit: negative

Final DiagnosisFinal Diagnosis

High-grade mostly necrotic High-grade mostly necrotic malignant neoplasmmalignant neoplasm