There’s more to Cytology than meets the Eye

Genevieve Warner Learmonth

When screening a slide, note carefully what you observe, no matter how odd it may seem,

Before you make up your mind,OPEN IT!

There’s a bone in her mouth!

But isn’t a giraffe herbivorous?

Cervical smear, age 40Screening programme

Primary screener: “carbon laden macrophages”

Or is it melanin?

Patient referred for Colposcopy & Biopsy

Brown lesion on ectocervix Histopathology: malignant melanoma

FNA Breast: on - site breast clinic

Screener phoned me and described “smear is black. I think I can see carbon laden macrophages”.

The aspirate looks like liquorice !”

Slides referred via vacuum tube direct to Cytology Laboratory

Cytology comment was queried by senior colleagues ,so the mass was excised, Histological findings --- probable lymph node relpaced by diffuse fibrosis and anthracosis. No lypmhoid tissue remaining. No epithelial cells present.Conclusion: Hut Breast

Further Enquiry

The female patient was admitted to hospital for investigation of dyspnoea ? TB.

Chest Xray showed diffuse fibrosis ? Pneumoconiosis. The mass in the upper outer

quadrant of the breast was an incidental finding !!

Patient was sent to the breast Clinic

Hut dweller from Transkei, inhalation of smoke in huts, termed “hut Lung” Prof Bateman ( GSH 1992). Mediastinal lymphatics are overwhelmed with carbon. Intramammary nodes involved as well as neck nodes.

FNA Mass in Right lower lobe of Lung, female 32yrs old.

CytologyReview

Primary screener: “highly atypical cells”.

Plentiful cytoplasm

Round nuclei

?Bronchiolar alveolar carcinoma?

Correlate with Chest Xray in view of age.

Review: Granular cytoplasm, suggestive of hepatic cells.

Xray Chest --- diaphragmatic hernia

Antero posterior Lateral

Cystic Mass 5cm in Supraclavicular area ?

nodePrimary screener: ? Talc granules

Too big , have another look

Have a look at High Power! Rostellum of hooklets, scolices, suckers---- Echinococcus granulosis

Histology: no laminated membrane, but

cross section of rostellum

FNA of Parotid Gland male age 35

Clear Fluid aspirated:

Primary screener: “Contaminants,

dust or pollen. Review: Scolices ENT surgeons:

Disbelief ! So “cut it out”

The specimen in the Bottle

Histological appearance

Laminated membrane, Echinococcus

What’s left in the bottle ?

Small monomorphic lymphocytes and ? “fibres”

Larva with constriction in gut Literature search

revealed several publications with similar MRI findings.

Eosinophilia not always a feature

Treat with Albendozole and cortisone

Patient got out of bed four days later

Repeat MRI

Clear CSF. ? Lymphoma

Primary screener : few lymphocytes Review: Lymphocytes degenerative

changes. No polymorphs. No eosinophils ? Larval worm ? Toxocara I conveyed my findings to the

clinicians, they came rushing to the lab with copies of the MRI.

Woman 45yr sudden onset transverse myelitis. Lower body paralysis. Arms paralysed. CSF clear fluid for cytology

? Larva of Toxocara

Bony lesion: Female sheep farmer from The Karoo, knee joint destroyed. ?Aneurysmal Bone Cyst.

Dedicated to the late Dr Moira Durcan