NON- GYNEA

1) Respiratory tract 2) Urine 3) Pleural, pericardial, and peritoneal fluids 4) Peritoneal washings 5) Cerebrospinal fluid 6) Gastrointestinal tract 7) Breast 8) Thyroid 9) Salivary gland 10) Lymph nodes 11) Liver 12) Pancreas 13) Kidney and adrenal gland 14) Ovary 15) Soft tissue

1) RESPIRATORY TRACT

NORMAL BENIGN MALIGNANT

NORMAL
Cytomorphology : Upper respiratory tract Ciliated columnar cells Squamous cells
Title: Ciliated columnar cell Source: http://www.czytelniamedyczna.pl/img/ryciny/newmed/2 007/04/images/20070411.jpg

Lower respiratory tract ‡ Trachea and bronchi Ciliated columnar cells Goblet cells Basal/reserve cells Neuroendocrine cells ‡ Terminal bronchioles Non ciliated cuboidal/columnar cells (Clara cells) Alveoli Type I and II pneumocytes Alveolar macrophages
Title: Goblet cell Source: http://www.siumed.edu/~dking2/erg/images/GI125a1.jpg

BENIGN

Cytomorphology Pulmonary hematoma Bland spindle cells Immature fibromyxoid matrix Mature cartilage with chondrocytes in lacunae Benign glandular cells Adipocytes Inflammatory myofibroblastic tumor Spindle cells Storiform pattern Polymorphous inflammatory cells Minimal to no necrosis Endobronchial granular cell tumor Small clusters of macrohage-like cells Abundant granular cytoplasm Small, uniform, round to oval nuclei
Title: cytomorphology of benign cell in respiratory tract Source:http://www.pathologyoutlines.com/caseofweek/case200710 0pap.jpg

MALIGNANT
Cytomorphology : Squamous cell carcinoma Abundant dyshesive cells Polygonal, rounded, or elongated cells Dense cytoplasmic orangeophilia (Papanicolou stain) Tadpole or fiber - like cells Pleomorphic, pyknotic nuclei Obscured nucleoli and chromatin detail Frequent anucleated cells Twisted keratin strands (Herxheimer spirals) Adenocarcinoma Cohesive sheets 3D clusters, acini Accentric, irregular nuclei Finely to coarsely granular chromatin Large nucleoli Secretory vacuoles Transparent, foamy cytoplasm
Title: Immunocytochemical positive staining for carcinoembryonic antigen (CEA) on the metastatic pulmonary adenocarcinoma in pleural fluid. Source : http://www.acta-cytol.com/feature/2007/feature022007.php Title : Squamous Cell Carcinoma Source : http://nih.techriver.net/patientImages/5713.jpg

2) URINE

NORMAL UROTHELIAL CELLS INFLAMMATION REACTIVE UROTHELIAL NEOPLASM LOW GRADE UROTHELIAL LESIONS HIGH GRADE UROTHELIAL CARCINOMA OTHER MALIGNANT LESIONS SQUAMOUS CELL CARCINOMA

NORMAL UROTHELIAL CELLS
Scanty cellularity in voided sample Cells are usually single in voided urine Clusters or sheets of urothelial cells in cystoscopy urine and bladder washings Umbrella cells, deeper layer cells, squamous cells seen A few polymorphs may be seen Spermatozoa and corpora amylacea may be present in males

Umbrella cells . These are the largest urothelial cells and cover the surface of the urothelium. Normal columnar urothelial cells are also pesent

(Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

INFLAMMATION

Hazy or turbid urine specimen Numerous polymorphs, histiocytes, occasionally eosinophil Reactive changes in epithelial cells Organisms may be present, bacteria or parasitic Evidence of associated pathology may be seen such as debris in the presence of calculi

Polyomavirus infection. The enlarged nucleus is virtually replaced by a glassy, homogeneous inclusion.

(Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

REACTIVE

N/C ratio: mild increase Cytoplasm: retain cytoplasmic clearing Nuclear borders : - normal Chromatic: finely granular Nucleoli: prominent in all cells Mitosis: few (if any) and normal

Reactive urothelial cells (catheterized urine). Coarsely vacuolated cytoplasm is characteristic of benign, reactive changes and uncommon in malignancy (Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

UROTHELIAL NEOPLASM

LOW GRADE UROTHELIAL LESIONS

Cytoplasmic homogeneity High nuclear to cytoplamic ratio Irregular borders Papillary fragments with fibrovascular cores(diagnostic, but rare) Cell clusters without cores Irregular cell clusters ( commonly associated with UC than smooth cell clusters)

cytologic criteria for the diagnosis of a low grade urothelial lesion (catheterized specimen). Homogeneous cytoplasm, an increased nuclear to cytoplasmic ratio, and irregular nuclear outline are associated with low-grade lesions, but are not specific. (Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

HIGH GRADE UROTHELIAL CARCINOMA

High nuclear to cytoplasmic ratio Marked nuclear hyperchromasia Coarsely granular chromatin Irregular nuclear outline Large nucleoli (some cases)

High-grade urothelial lcarcinoma. Numerous isolated malignant cells have enlarged, dark nuclei and an increased nuclear to cytoplasmic ratio. (Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

OTHER MALIGNANT LESIONS

SQUAMOUS CELL CARCINOMA

Cytoplasmic keratinization Pearls Bridges Angulated hyperchromatic nuclei

Urothelial carcinoma (Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

3) PLEURAL, PERICARDIAL AND PERITONEAL FLUIDS (EFFUSIONS)

BENIGN MALIGNANT

BENIGN

Benign effusions contain mesothelial cells, histiocytes and lymphocytes.

Cytomorphology Mesothelial cells Numerous, isolated cells, small cluster with windows , single nucleolus, dense cytoplasm with clear outer rim (lacy skirt), round cells and nucleus. Histiocytes Smaller nuclei than mesothelial cells, folded nuclei, cytoplasm granular/vacuolated, no windows between adjacent cells.

MALIGNANT

Tips for detection: Second population, numerous large clusters and lacunae (cell block sections). Cytomorphology Malignant mesothelioma ~Common pattern Large cluster with scalloped (knobby) edges, cytomegaly, prominent nucleoli, bi/multinucleation, dense cytoplasm with peripheral halo, windows, normal nc ratio, round and center nuclei. ~Uncommon pattern Predominant isolated tumor cells, lymphocytes only, tumor cells with abundant lymphocytes and histiocytes, psammoma bodies and cytoplasmic vacuolation.

4) PERITONEAL WASHING

NORMAL MALIGNANT

NORMAL

- Mesothelial cells in sheets and clusters. - Collagen balls 5% - Histiocytes muscle. - Adipose tissue

MALIGNANT

Isolated cells and clusters. Large cells. Marked variation in nuclear size. Nuclear hyperchromasia. Prominent nucleoli. Mitoses. Vacuolated cytoplasm (some cells)
Peritoneal wash: Suspicious for pancreatic carcinoma.60x . Cells in cluster. http://www.cytologystuff.com/indexnongyn.htm?section9ng .htm

Peritoneal wash: Suspicious for pancreatic carcinoma . Cells in cluster with larger cells and variation in nuclear size. Vacuoalation cytoplasm seen. http://www.cytologystuff.com/indexnongyn.htm?section9ng. htm

5) CEREBROSPINAL FLUID

NORMAL BENIGN MALIGNANT

NORMAL

Common ‡ Lymphocytes ‡ Monocytes Rare ‡ Choroid plexus /ependymal cells ‡ Brain fragment ‡ Germinal matrix ‡ Chondrocytes ‡ Bone marrows

Title : Normal cell in CSF . Dark purple stain is lymphocyte. Source: http://serc.carleton.edu/images/woburn/all_csf_150.jpg

BENIGN

Abnormal inflammatory cells Plasma cells Macrophage Neutrophils Non neoplastic disorder Numerous neutrophils Bacteria Viruses Fungi
Title: Cytomorphology of fungal (cryptococcus sp.) infection in cerebrospinal fluid. Source:http://sociedaddecitologia.org.ar/sac/images/stories/galerias/criptoc ocosis/dsc00371.jpg

MALIGNANT

Cytomorphology : Adenocarcinoma Large cells Isolated or small cluster Abundant cytoplasm Accentric nucleus Small cell carcinoma Small cells Isolated or small cluster Abundant cytoplasm Accentric nucleus
Title: Diff Quick staining of the cerebrospinal fluid reveals adenocarcinoma Source:http://img.medscape.com/fullsize/migrated/507/124/mgm507124.fi g2.gif

6) GASTROINTESTINAL TRACT

ESOPHAGUS
Barrett s esophagus , Dysplasia in Barrett s esophagus Low-grade dysplasia, High-grade dysplasia Adenocarcinoma Squamous cell carcinoma Uncommon tumors

STOMACH
Adenocarcinoma

DUODENUM
Adenoma and Adenocarcinoma

ESOPHAGUS

Barrett s esophagus Cytomorphology: Epithelial repair Goblet cells

Differential diagnosis Intestinal metaplasia of the gastric cardia

Dysplasia in Barrett s esophagus Cytomorphology Background of Barrett s epithelium

Barrett s epithelium with goblet cells. A single large cytoplasmic vacuole expands the apical portion of the cytoplasm and displaces the nucleus and shapes it into a crescent against the basal cell membrane

Scattered atypical cells with some but not all features of adenocarcinoma

Low-grade dysplasia Cytomorphology: Crowded groups with stratification Mild nuclear atypia and pleomorphism
Low-grade dysplasia in Barrett s epithelium. A fragment of glandular epithelium with stratified elongated nuclei is seen. Although mucin depletion and slight nuclear enlargement are seen, significant nuclear atypia is absent.

High-grade dysplasia Cytomorphology Crowded groups or isolated cells Higher degree of nuclear atypia and pleomorphism

Differential diagnosis Regenerative epithelium adenocarcinoma

High grade dysplasia in Barrett s epithelium. A sheet of irregular arranged cell with variable enlarged nuclei is present without evident dyshesion. In spite of the increase nuclear to cytoplasmic ratio, nuclear membrane irregularities, and slight hyperchromasia, the atypia is insufficient for a definitive diagnosis of malignancy.

Adenocarcinoma Cytomorphology: Increased cellularity Abnormal cellular arrangement Atypical nuclear features Various amount of vacuolated cytoplasm Tumor diathesis Barrett s epithelium may or may not be present in the background
Adenocarcinoma. The nuclei show significant hyperchromasia with chromatin clumping and clearing and large prominent nucleoli.

Differential diagnosis Epithelial repair Dysplasia in Barrett s epithelium, particularly high grade Poorly differentiated squamous cell carcinoma

Squamous cell carcinoma Cytomorphology well differentiated squamous cell carcinoma: Hyperchromatic / pyknotic nuclei Completely obscured chromatin Variable cell shapes (round, oval or spindled) Irregular, angulated nuclei Keratinized cytoplasm ( hard or glassy orangeophilia) Sharp cytoplasmic border Prominent necrosis/ tumor diathesis

Cytomorphology poorly differentiated squamous cell carcinomas Less keratinization, nuclear angularity, and pyknosis Indistinct cell borders Coarsely textured chromatin Prominent nucleoli

Well-differentiated squamous cell carcinoma. Two spindled-shaped keratinized malignant-squamous cells with orangeophilic cytoplasm and hyperchromatic nuclei show markedly abnormal chromatin distribution. Degenerated cells with pyknotic nuclei are in the background.

Uncommon tumors
Cytomorphology uncommon tumors: Verrucous carcinoma Minimal cytologic atypia Adenosquamous carcinoma Both malignant squamous and glandular elements Mucoepidermoid carcinoma Mucinous, squamous, and intermediate cell s in varying proportions Basaloid carcinoma Tight and loose groups of crowded dark basaloid cells Often misdiagnosed as an adenoid cystic carcinoma Adenoid cystic carcinoma Cribriform, pseudoacinar, and small duct-like structures Small cell carcinoma Small or intermediate-sized cells Scant cytoplasm Prominent molding Necrosis and nuclear streaking common
Helicobacter pylori (gastric brushings). Numerous faintly basophilic S-shaped rods are entrapped in mucus.

STOMACH

Adenocarcinoma Cytomorphology signet ring cells Small groups or isolated cells Vacoulated cytoplasm, often a single large vacuole Crescent-shaped, angulated, hyperchromatic nuclei

Signet ring cell carcinoma (gastric brushings). A group of malignant signet ring cells is seen. They have characteristic large vacuoles that shape the nucleus into a crescent against the cell membrane. In contrast to benign goblet cells, the nuclei in malignant signet ring cells are hyperchromatic and angulated

DUODENUM

Adenoma and Adenocarcinoma Cytomorphology: Cohesive three-dimensional clusters of crowded epithelial cells Increased nuclear to cytoplasmic ratio Absent goblet cells Palisading and molding of elongated nuclei Fine chromatin and absent or small nucleoli
Ampullary adenoma (ampullary brushings). A crowded group of glandular cells with mucin depletion and an increased nuclear to cytoplasmic ratio is present. A gland opening is apparent. In spite of the crowding, the arrangement is orderly. The nuclei are enlarged and elongated but significant atypia is present.

7) BREAST

BENIGN MALIGNANT

BENIGN

Cytomorphology ~Fibroadenoma Hypercellular Large honeycomb sheets, 3D clusters with antler-like configuration, bipolar cells and spindled/oval naked nuclei, fibrillar stromal fragments (bluish gray with Papanicolaou stain/intensely red-purple with Romanowsky type stain), nuclear atypia, some loss of epithelial cohesion, regular nuclear spacing, finely granular chromatin pattern, small and round nuclei.

MALIGNANT

Cytomorphology - Breast cancer

Tubular carcinoma Hypercellular smear due to dense of fibrosis, predominantly cohesive, often angular clusters(comma-shaped or cornucopia-shaped), some dyshesion, uniform, mediumsized tumor cells with round, uniform nuclei, fine granule chromatin, small nucleoli and occasionally cells have large cytoplasmic vacuole. -Uncommon breast tumor Aporine carcinoma Hypercellular specimen, cluster, sheets and isolated cells, abundant granular cytoplasm with indistinct cell borders, enlarged nuclei with irregular contours, prominent large nucleoli and necrotic debris.

8) THYROID

BENIGN MALIGNANT Papillary carcinoma Anaplastic carcinoma Medullary carcinoma Lymphoma

BENIGN CONDITIONS

Subacute granulomatous (De Quervain s) thyrioditis Cytomorphology: Granulomas Giant cells Lymphocytes
Hashimoto s thyroiditis. Lymphoid cells are the predominant feature. Most are small, mature lymphocytes.

Chronic lymphocytic (Hashimoto s) thyroiditis Cytomorphology: Mixed population of lymphocytes Tingible-body macrophages Lymphohistiocytic aggregates
Hashimoto s thyroiditis. Hurthle cell with abundant cytoplasm are usually identified in clusters.

MALIGNANT TUMORS
Papillary carcinoma Cytomorphology: Sheets, papillae, or microfollicles Nuclear changes powdery chromatin Grooves Pseudoinclusions Nucleoli (small or large) Membrane irregularity Nuclear crowding/molding Variable cytoplasm (scant, squamoid, Hurthle-like, or vacuolated) Psammoma bodies Histiocytes, including multinucleated giant cells
Suspicious for a Hurthle cell neoplasm. These enlarged cells with abundant granular cytoplasm were interpreted as suspicious, but the patient proved to have a multnodular goiter with extensive clear cell change.

Papillary carcinoma. In some cases, papillae are absent, and the neoplastic cells are arranged in crowded sheets. Psammoma bodies are present.

Anaplastic carcinoma Cytomorphology: Mostly single cells Marked nuclear pleomorphism Large cells Epithelioid or spindle shaped Squamous differentiation (some cases) Giant cells Tumor type Osteoclast type
Anaplastic carcinoma. Tumor cells are dispersed as isolated cells. Nuclei are large, hyperchromatic, and irregular shaped.

Medullary carcinoma Cytomorphology: Numerous single cells Loose clusters Epithelioid, plasmacytoid, and/or spindle-shaped cells Nuclei Round or elongated Finely or coarsely granular chromatin Inconspicious nucleoli Pseudoinclusion (50% of cases) multinucleated Red cytoplasmic granules (70% of cases) amyloid
Medullary carcinoma. Air-dried Romanowskystained preparation show fine red cytoplasmic granules, a helpful diagnostic features. Medullary carcinoma. Smears show numerous isolated cells and small blobs of amyloid. (arrows)

Lymphoma Cytomorphology MZL type: Small lymphoid cells Centrocytes Plasma cells Monocytoid B cells Interspersed large lymphoid cells

Cytomorphology DLBL type: Large lymphoid cells Centroblast Immunoblasts Burkitt-like cells
Marginal zone B-cell lymphoma of MALT type. The neoplastic lymphoid cells are uniformly small, with irregularly shaped nuclei a moderate amount of cytoplasm.

9) SALIVARY GLAND

NORMAL BENIGN MALIGNANT CARCINOMA & ADENOCARCINOMA SMALL CELL CARCINOMA

NORMAL

Serous and mucinous-type acinar cells Small sheets and tubules of ductal epithelium Adipose tissue

Title: Major of salivary gland cell Source: http://flylib.com/books/2/953/1/html/2/21%20%20Serous%20Membranes_files/DA6C21FF4.png

BENIGN

Epithelial cells Myoepithelial cells Chondromyxoid matrix

Title: Aspiration from benign salivary gland Source:http://www.nature.com/modpathol/journal/v15/n3/thumbs/388052 8f4th.jpg

MALIGNANT CARCINOMA & ADENOCARCINOMA

Cytomorphology: Carcinoma Mucus cells ( predominate in low grade tumors) Intermediate cells Mucinous background Overt cytology malignancy (high grade tumors) Adenocarcinoma Cellular aspirate of biphasic cells in 3D cluster Large clear myoepithelial cells with moderate to abundant cytoplasm and vesicular nuclei Small dark ductal cells with scant cytoplasm Peripheral homogenous acellular basement membrane material Background naked nuclei

Title: Interpretation of suspicious adenoid cystic carcinoma Source: http://www.pathologyimagesinc.com/sgt-cytopath/chronic-inflammsialadenitis/cytopathology/diff-diagn/fs-chr-sialad-dd.html

Title: Metastatic squamous cell carcinoma Source:http://pathology2.jhu.edu/cytopath/masterclass/images/salivary/1sa lp3a.jpg

MALIGNANT SMALL CELL CARCINOMA
Small cell carcinoma Extranodal marginal zone B-cell lymphoma of MALT type Small to intermediate size lymphocytes Round to slightly irregular nuclei Occasional immunoblasts CD 45+, CD20+, CD23-, CD10-,CD5-, cyclin D1Folicular lymphoma Mixed population of small and large cleaved and large non-cleaved cells CD45+, CD20,CD10+,CD5Diffuse large B-cell lymphoma Large markedly atypical lymphocytes CD45+,CD20+, keratin-, S-100-

10) LYMPH NODES

NON ² NEOPLASTIC LESIONS NEOPLASMS

NON ² NEOPLASTIC LESIONS

Cytomorphology - Reactive hyperplasia ~ Polymorphous population, small lymphocytes, centrocytes, centroblast, immunoblast, tingible body macrophages, lymphohistiocytic aggregates, capillaries, eosinophils and mast cells.

-Inflammatory/infectious condition ~Sarcoidosis - Granulomas, epithelioid histiocytes, multinucleated giant cells, lymphocytes and clean background.

NEOPLASMS

Cytomorphology Hodgkin Lymphoma Small lymphocytes, eosinophils (especially in mixed cellularity subtype), Reed Sternberg cells, classic and mononuclear variants, no lymphohistiocytic aggregates/tingible body macrophages (exceptions: partial node involvement and lymphocyte predominant Hodgkin lymphoma) Non-Hodgkin Lymphoma (small lymphocytic lymphoma) Monomorphous small lymphocytes clumped chromatin, smooth/minimally irregular nuclear contour, small nucleoli, scant cytoplasm, prolymphocytes and paraimmunoblasts, no tingible body macrophages or lymphohistiocytic aggregates.

11) LIVER FNAC

NORMAL MALIGNANT

NORMAL
Hepatocytes Large polygonal cells. Isolated cells, thin ribbons (trabeculae), or larger tissue fragments. Centrally placed, round to oval and variably sized nuclei. Commonly binucleated Prominent nucleoli Intranuclear pseudoinclusions. Abundant granular cytoplasm.

Pigment:
a)Lipofuscin (common:a normal pigment related to cellular aging-golden with the Papanicolaou strain and green-brown with a Romanosky-type strain. b)Homosiderin: (less common : when present in large quantities it suggests a disoder of iron matabolism)-dark brown with the Papanicolaou strain and blue with with a Ramonowsky-type strain. c)Bile( not visible under normal conditions but seen in cholestasis) -dark green with both Papanicolaou and Romanosky strain.

MALIGNANT

MALIGNANT:
Highly cellular smears with single cells or cords, nests, tubules, or sheets. Spindle-shaped endothelial cells surround thickened cords of neoplastic hepatocytes. Neoplastic hepatocytes have an increased nuclear to cytoplasmic ratio Granular cytoplasm with bile or hyaline globules( red with Papanicolaou and blue with Romanosky stains) Large, round nuclei with prominent nucleoli Intranuclear pseudoinclusions. Large naked nuclei.

Malignant: liver FNAC

Liver FNA, Hepatocellular Carcinoma. Poorly differentiated hepatocellular carcinoma in which the hepatocytes show marked nuclear enlargement with nuclear irregularity and very prominent nucleoli. 60x http://www.cytologystuff.com/indexnongyn.htm

Liver FNA, Hepatocellular Carcinoma. Loose cluster of malignant hepatocytes from an aspirate of hepatocellular carcinoma. There is uniform atypicality with increased nuclear-to-cytoplasmic ratios. Some bile pigment is noted between the hepatocytes. 40x

Liver FNA - Cirrhosis Individually scattered benign binucleated hepatocytes from a cirrhotic nodule. 40x http://www.cytologystuff.com/indexnongyn.htm

12) PANCREAS

BENIGN PANCREATIC ACINAR EPITHELIUM PANCREATIC DUCTAL EPITHELIUM REACTIVE NEOPLASM DUCTAL ADENOCARCINOMA ACINAR CELL CARCINOMA

BENIGN PANCREATIC ACINAR EPITHELIUM

acinar arrangement or isolated cells eccentrically placed, round nucleus evenly distributed, finely granular chromatin inconspicuous nucleolus abundant granular cytoplasm indistinct cell borders

Normal pancreatic acinar cells (Papanicolaou stain) (Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

PANCREATIC DUCTAL EPITHELIUM

Flat, cohesive epithelial sheets (few single cells) Round to oval nuclei Evenly distributed, finely granular chromatin Even nuclear spacing Well defined cytoplasmic boundaries No nuclear crowding or overlapping

A

B
Pancreatic ductal epithelial cells. (a) Forming a honeycomb sheet. (b) Palisading groups with basally located nuclei

(Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

REACTIVE REACTIVE DUCTAL ATYPIA

Low cellularity Flat, cohesive sheets Uniformly spaced nuclei Round to oval nuclear contours Rare intact single atypical cells

Marked reactive atypia of ductal epithelium in the setting of chronic pancreatitis. (a)Note the nuclear enlargement and overlapping, and prominent nucleoli. (b) The nuclear are basally located, however, with smooth, round contours and evenly distributed chromatin. (Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

NEOPLASMS DUCTAL ADENOCARCINOMA
(Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

a

Increased cellularity Cohesive epithelial sheets ( with rounded edges) Nuclear crowding and overlapping Increased intracytoplasmic mucin Focally irregular nuclear contours (pyramidal and carrot-shaped nuclei) Nuclear enlargement (particularly marked anisonucleosis within a single sheet) Irregular chromatin clearing
Pancreatic ductal adenocarcinoma (a) Compare the appearance of this disordered, crowded Sheet with the normal ductal epithelium. (b) Irregular nuclear Contours and marked nuclear enlargement are evident. (c) Irregular chromatin distribution and hyperchromasia.

b

c

ACINAR CELL CARCINOMA

Groups of cells in nest, cords, or acini Increased single cells Nuclear irregularity, crowding, overlapping Increased nuclear to cytoplasmic ratio Conspicuous nucleoli Absence of ductal epithelium

Acinar cell carcinoma (http://en.wikipedia.org/wiki/File:Acinic_cell_carcinoma.jpg)

13) KIDNEY AND ADRENAL GLAND (FNA)
KIDNEY AND ADRENAL GLAND NORMAL MALIGNANT KIDNEY NORMAL Glomeruli, Proximal tubular cell & Distal tubular cell Oncocytoma MALIGNAT Clear cell type chromophobe type ADRENAL GLAND NORMAL MALIGNANT Adrenal cortical carcinoma Pheochromocytoma and Metastatic carcinoma

NORMAL: KIDNEY AND ADRENAL GLAND

Glomeruli: Cytomorphology: Large papillary structures. Capillary loops. Differential diagnosis: Papillary RCC ( renal cell carcinoma) Proximal tubular cells: Cytomorphology: Rare cells with abundant granular cytoplasm. Differential diagnosis: Oncocytoma Chromophobe RCC Distal tubular cells: Cytomorphology: Rare cells with scant cytoplasm and minimal atypia. Differential diagnosis Low grade clear cell or papillary RCC

MALIGNANT: KIDNEY AND ADRENAL GLAND (FNA)

MALIGNANT: Clear cell/ conventional renal cell carcinoma Cytomorphologic: Large cohessive groups. Abundant clear and granular cytoplasm. Large, round, eccentrically placed nucleus with prominent nucleolus. Differential diagnosis: Large cohessive groups Abundant clear and granular cytoplasm. Large, around, eccentrically placed nucleus with prominent nucleolus

NORMAL: KIDNEY FNAC

Oncocytoma: Clean Background Dyshesive Single Cells or Loose Clusters, No Stripped Nuclei Rarely in Large Groups (Unlike RCC) Small Uniform Nuclei, Smooth Borders (Unlike RCC) Focal Nuclear Atypia, Binucleation, Inconspicuous Nucleoli Abundant Uniformly Granular Well-defined Cytoplasm No Vacuoles (Unlike RCC) Sharp Well Defined Cell Border (Unlike PCT Cells) Hale's Colloidal Iron Negative, or Perinuclear/atypical Staining Present Electron Microscopy: Mitochondria MIMICS: PCT, Chromophobe RCC, Conventional RCC with Granular Cytoplasm Renal Cell Carcinoma

http://www.cytologystuff.com/indexnongyn.htm

Kidney - oncocytoma 60x

MALIGNANT: KIDNEY (FNA)

Conventional/common/clear cell type (CRCC): Clean or necrotic background Cohesive monolayered sheets (unlike oncocytoma) Prominent branching capillaries rare single cells (low grade) ® more single cells and stripped nuclei (higher grades) (unlike oncocytoma) Bland nuclei, no nucleoli (low grade) Larger atypical nuclei, some bizarre, nucleoli prominent (higher grade), (unlike oncocytoma, chromophobe RCC). Eccentric nucleus, extruded from cells More uniform nuclei than chromophobe rcc Foamy vacuolated cytoplasm (unlike onc and normal) Clear, or granular (not uniform) abundant cytoplasm (low N/C ratio) Intracytoplasmic mallory-like bodies Vimentin, cytokeratin positive (use biotin block) Hale's colloidal iron negative Electron microscopy: glycogen, lipid; mitochondria in some MIMICS: distal convoluted tubule and collecting duct, oncocytoma, chromophobe RCC

Chromophobe Type:
Clean background Sheets, clusters, single cells (dyshesive, but less than CRCC) Bare nuclei (unlike oncocytoma) More variation in cell & nuclear size (than oncocytoma, CRCC) Vesicular nuclei, binucleation, inclusions Irregular nuclear outline (unlike oncocytoma, CRCC) Prominent nucleoli in some abundant granular cytoplasm Perinuclear clearing, prominent cell borders ("koilocytic") Fluffy/clear/granular not uniform cytoplasm Vimentin negative, cytokeratin positive (use biotin block) Hale's colloidal iron positive - uniform, dense, cytoplasmic Electron microscopy: microvesicles; mitochondria if eosinophilic variant MIMICS: oncocytoma, CRCC

http://www.cytologystuff.com/indexnongyn.htm

http://www.cytologystuff.com/indexnongyn.htm
Malignant: Kidney (FNA)

Kidney - renal cell carcinoma Conventional type. Monolayered sheets of foamy vacuolated cells with low N/C ratios, eccentric nuclei, minimal nuclear atypia and small nucleoli. Nuclei appear uniform. 40x

Kidney - renal cell carcinoma Conventional type. Cluster of foamy vacuolated cells with eosinophilic intracytoplasmic Mallorylike bodies. 60x

NORMAL: ADRENAL GLAND (FNA)

http://www.cytologystuff.com/indexnongyn.htm

Abundant foamy granular lipid rich background appears in clumps on thin layer. Entrapped vacuolated cells with round bland regular nuclei. Note bare stripped nuclei as well. 40x

Adrenal gland - normal cortex Clusters of vacuolated cells with bland round smoothly contoured nuclei, small nucleoli and fragile frayed cytoplasmic edges. 60x

http://www.cytologystuff.com/indexnongyn.htm
MALIGNANT: ADRENAL GLAND (FNA)

MALIGNANT: Adrenal cortical carcinoma MIMICS Adenoma Features Necrosis May be Present May See Malignant Nuclear Criteria Histological Assessment Required to Distinguish Larger Adenomas from Carcinomas Similar Immunoprofile as Adenoma MIMICS: May be Indistinguishable from Normal Adrenal Gland and Adrenal Cortical Adenoma; Pheochromocytoma, Other Malignancies, if Poorly Differentiated

http://www.cytologystuff.com/indexnongyn.htm

http://www.cytologystuff.com/indexnongyn.htm

Adrenal gland, Metastatic adenocarcinoma Prominent 3-D cell ball formation without intercellular windows indicating glandular differentiation. 60x

Adrenal gland, Metastatic adenocarcinoma 60x

Adrenal gland, Metastatic small cell carcinoma 60x

Adrenal gland, Metastatic small cell carcinoma 60x

14) OVARY

BENIGN Serous cystadenoma and cystadenofibroma, Mucinous cystadenoma MALIGNANT ~Papillary serous cystadenoma of low malignant potential and serous cystadenocarcinoma ~Mucinous cystadenoma of low malingnant potential and cystadenocarcinoma ~Endometrioid carcinoma

BENIGN EPITHELIAL NEOPLASMS
Serous cystadenoma and cystadenofibroma Cytomorphology: Cuboidal cells Ciliated cells Detached ciliary tufts Psammoma bodies (rare)
Serous cystadenoma. Benign ciliated cells have basally placed nuclei, terminal bars, and cilia.

Mucinous cystadenoma Cytomorphology: Mucinous cells Isolated cells, ribbons, sheets Macrophages Extracellular mucin
Mucinous cystadenoma. Among the macrophages are fragments of benign mucinous epithelium endocervial epithelium.

MALIGNANT EPITHELIAL NEOPLASMS
Papillary serous cystadenoma of low malignant potential and serous cystadenocarcinoma Cytomorphology: serous tumor of low malignant potential Twisted sheets and spheres Branching clusters Mild to moderate nuclear atypia Large cytoplasmic vacuoles (some cells) Psammoma bodies Stripped fibrovascular cores
In this tight spherical aggregate, some cells have large cytoplasmic vacuoles Serous of low malignant potential tumor. The cells are arranged in a crowded sheet. There is mild to meoderate atypia.

Cytomorphology: serous cystadenocarcinoma Cluster and isolated cells Large pleomorphic cells Round nuclei Prominent nucleoli Psammoma bodies

Psammoma bodies are a common finding

Mucinous cystadenoma of low malingnant potential and cystadenocarcinoma

Cytomorphology: Mucinous cystadenoma Columnar mucinous cells with mild atypia and/or groups of pleomorphic large cells with prominent nucleoli Cytoplasmic vacuolization Macrophages

Papillary serous cystadenocarcinoma. The malignant cell often have large, round and pleomorphic nuclei, and nucleoli and prominent

Other cells are markedly atypical and difficult to recognize as mucinous origin

Mucinous cystadenocarcinoma. Some sheets of mucinous cells show only mild atypia

Endometrioid carcinoma Cytomorphology: Numerous isolated cells Strips and/or crowded glands Palisading Elongated columnar shape Clear cell carcinoma

Endometrioid adenocarcinoma. The cells have elongated nuclei and a narrow columnar shape. Some are arranged in pseudostratified strips and glands.

15) SOFT TISSUE

SPINDLE CELL NEOPLASMS LEIOMYOSARCOMA SCHWANNOMA ROUND CELL NEOPLASM DESMOPLASTIC SMALL ROUND CELL TUMOR ALVEOLAR RHABDOMYOSARCOMA
CONTENTS

SPINDLE CELL NEOPLASMS LEIOMYOSARCOMA

Naked nuclei Loose clusters Spindle-shaped cells cigar-shaped nuclei Abundant homogeneous cytoplasm mitoses
Leiomyosarcoma. Nuclei are hyperchromatic with finely or slightly coarsely granular chromatin in lower-grade lesions and more coarsely clumped chromatin in the high-grade lesions. (Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

SCHWANNOMA

Large, cohesive fragments Wavy, fishlook nuclei Pointed nuclear ends Nuclear palisading Filamentous cytoplasm

Schwannoma. The cells of benign schwannoma grow in a syncytial fashion with indistinct cell borders

(Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

ROUND CELL NEOPLASM DESMOPLASTIC SMALL ROUND CELL TUMOR

Sheets and clusters of cells Fragments of variably cellular stroma Uniformly round to oval cells Nuclear molding

Desmoplastic small round cell tumor. This differs from other round cell lesions in That its undifferentiated neoplastic cells retain a loose cohesiveness and are rarely Singly dispersed.

(Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

ROUND CELL NEOPLASM ALVEOLAR RHABDOMYOSARCOMA
Larger, uniformly round to polygonal cells Predominantly undifferentiated cells ( early rhabdomyoblasts) Multinucleated giant tumor cells

Alveolar rhabdomyosarcoma. The cells disperse individually, but are generally larger and more uniformly round to polygonal than those seen in embryonal rhabdomyosarcoma

.

(Diagnostic principles and clinical correlates cytology, 2nd edition, Edmund and Barbara)

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