NON- GYNEA

1) Respiratory tract2) Urine 3) Pleural, pericardial, and peritoneal fluids4) Peritoneal washings5) Cerebrospinal fluid6) Gastrointestinal tract7) Breast8) Thyroid9) Salivary gland10)Lymph nodes11)Liver12)Pancreas13)Kidney and adrenal gland14)Ovary15)Soft tissue

1) RESPIRATORY TRACT

NORMAL BENIGN MALIGNANT

Cytomorphology :

Upper respiratory tract

Ciliated columnar cells Squamous cells

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: Ciliated columnar cell Source: http://www.czytelniamedyczna.pl/img/ryciny/newmed/2007/04/images/20070411.jpg

Title: Goblet cell Source: http://www.siumed.edu/~dking2/erg/images/GI125a1.jpg

NORMAL

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 tractSource:http://www.pathologyoutlines.com/caseofweek/case2007100pap.jpg

BENIGN

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 : Squamous Cell CarcinomaSource : http://nih.techriver.net/patientImages/5713.jpg

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

MALIGNANT

2) URINE

NORMAL UROTHELIAL CELLS

INFLAMMATION REACTIVE UROTHELIAL NEOPLASM

LOW GRADE UROTHELIAL LESIONSHIGH GRADE UROTHELIAL CARCINOMA

OTHER MALIGNANT LESIONSSQUAMOUS CELL CARCINOMA

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)

NORMAL

UROTHELIAL CELLS

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)

INFLAMMATION

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)

REACTIVE

Cytoplasmic homogeneityHigh nuclear to cytoplamic ratioIrregular bordersPapillary fragments with fibrovascular cores(diagnostic, but rare)Cell clusters without coresIrregular 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)

UROTHELIAL NEOPLASM

LOW GRADE UROTHELIAL LESIONS

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)

HIGH GRADE UROTHELIAL CARCINOMA

Cytoplasmic keratinization Pearls Bridges Angulated hyperchromatic nuclei

Urothelial carcinoma

(Diagnostic principles and clinical correlates cytology,

2nd edition, Edmund and Barbara)

OTHER MALIGNANT LESIONS

SQUAMOUS CELL CARCINOMA

3) PLEURAL, PERICARDIAL AND PERITONEAL FLUIDS

(EFFUSIONS)

BENIGN MALIGNANT

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.

BENIGN

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

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

NORMAL

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 .Cells in cluster with larger cells and variation in nuclear size.

Vacuoalation cytoplasm seen.http://www.cytologystuff.com/indexnongyn.htm?

section9ng.htm

Peritoneal wash: Suspicious for pancreatic carcinoma.60x .Cells in cluster.

http://www.cytologystuff.com/indexnongyn.htm?section9ng.htm

MALIGNANT

5) CEREBROSPINAL FLUID

NORMAL BENIGN MALIGNANT

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

NORMAL

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/criptococosis/dsc00371.jpg

BENIGN

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 adenocarcinomaSource:http://img.medscape.com/fullsize/migrated/507/124/mgm507124.fig2.gif

MALIGNANT

6) GASTROINTESTINAL TRACT

ESOPHAGUSBarrett’s esophagus , Dysplasia in Barrett’s esophagusLow-grade dysplasia, High-grade dysplasiaAdenocarcinomaSquamous cell carcinomaUncommon tumors

STOMACHAdenocarcinoma

DUODENUMAdenoma and Adenocarcinoma

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

Scattered atypical cells with some but not all features of adenocarcinoma

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

ESOPHAGUS

Low-grade dysplasia

Cytomorphology:

Crowded groups with stratification

Mild nuclear atypia and pleomorphism

High-grade dysplasia

Cytomorphology

Crowded groups or isolated cells

Higher degree of nuclear atypia and pleomorphism

Differential diagnosis

Regenerative epithelium

adenocarcinoma

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 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

Differential diagnosis

Epithelial repair

Dysplasia in Barrett’s epithelium, particularly high grade

Poorly differentiated squamous cell carcinoma

Adenocarcinoma. The nuclei show significant hyperchromasia with chromatin clumping and clearing and large prominent nucleoli.

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 tumorsCytomorphology – 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.

Adenocarcinoma

Cytomorphology – signet ring cells

Small groups or isolated cells

Vacoulated cytoplasm, often a single large vacuole

Crescent-shaped, angulated, hyperchromatic nuclei

STOMACH

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

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

DUODENUM

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

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.

BENIGN

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, medium-sized 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.

MALIGNANT

8) THYROID

BENIGN MALIGNANT

Papillary carcinomaAnaplastic carcinomaMedullary carcinomaLymphoma

Subacute granulomatous (De Quervain’s) thyrioditis

Cytomorphology:

Granulomas

Giant cells

Lymphocytes

Chronic lymphocytic (Hashimoto’s) thyroiditis

Cytomorphology:

Mixed population of lymphocytes

Tingible-body macrophages

Lymphohistiocytic aggregates

BENIGN CONDITIONS

Hashimoto’s thyroiditis. Lymphoid cells are the predominant feature. Most are small, mature lymphocytes.

Hashimoto’s thyroiditis. Hurthle cell with abundant cytoplasm are usually identified in clusters.

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

MALIGNANT TUMORS

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. Smears show numerous isolated cells and small blobs of amyloid. (arrows)

Medullary carcinoma. Air-dried Romanowsky-stained preparation show fine red cytoplasmic granules, a helpful diagnostic features.

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 & ADENOCARCINOMASMALL CELL CARCINOMA

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

NORMAL

Epithelial cells Myoepithelial cells

Chondromyxoid matrix

BENIGN

Title: Aspiration from benign salivary gland Source:http://www.nature.com/modpathol/journal/v15/n3/thumbs/3880528f4th.jpg

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

MALIGNANT

CARCINOMA & ADENOCARCINOMA

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

Title: Metastatic squamous cell carcinomaSource:http://pathology2.jhu.edu/cytopath/masterclass/images/salivary/1salp3a.jpg

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 D1-

Folicular lymphoma Mixed population of small and large cleaved and large non-cleaved cells

CD45+, CD20,CD10+,CD5-

Diffuse large B-cell lymphoma Large markedly atypical lymphocytes

CD45+,CD20+, keratin-, S-100-

MALIGNANT

SMALL CELL CARCINOMA

10) LYMPH NODES

NON – NEOPLASTIC LESIONS NEOPLASMS

NON – 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.

Cytomorphology

Hodgkin LymphomaSmall 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.

NEOPLASMS

11) LIVER FNAC

NORMAL MALIGNANT

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.

NORMAL

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 FNA - CirrhosisIndividually scattered benign binucleated hepatocytes

from a cirrhotic nodule. 40x 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

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

12) PANCREAS

BENIGN

PANCREATIC ACINAR EPITHELIUM

PANCREATIC DUCTAL EPITHELIUM

REACTIVE NEOPLASM

DUCTAL ADENOCARCINOMAACINAR CELL CARCINOMA

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)

BENIGN

PANCREATIC ACINAR 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

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)

PANCREATIC DUCTAL EPITHELIUM

A

B

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)

REACTIVE

REACTIVE DUCTAL ATYPIA

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.

a

b

c

NEOPLASMS

DUCTAL ADENOCARCINOMA

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

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)

ACINAR CELL CARCINOMA

13) KIDNEY AND ADRENAL GLAND (FNA)

KIDNEY AND ADRENAL GLAND NORMALMALIGNANT

KIDNEYNORMAL

Glomeruli, Proximal tubular cell & Distal tubular cellOncocytoma

MALIGNATClear cell typechromophobe type

ADRENAL GLANDNORMALMALIGNANT

Adrenal cortical carcinomaPheochromocytoma and Metastatic carcinoma

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

NORMAL: KIDNEY AND ADRENAL GLAND

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

MALIGNANT: KIDNEY AND ADRENAL GLAND (FNA)

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

Kidney - oncocytoma60x

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

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

Kidney - renal cell carcinomaConventional type. Cluster of foamy vacuolated cells with eosinophilic intracytoplasmic Mallory-

like bodies. 60x

Malignant: Kidney (FNA)

Kidney - renal cell carcinomaConventional type. Monolayered sheets of foamy

vacuolated cells with low N/C ratios, eccentric nuclei, minimal nuclear atypia and small nucleoli. Nuclei appear

uniform. 40x

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

NORMAL: ADRENAL GLAND (FNA)

Adrenal gland - normal cortex Clusters of vacuolated cells with bland round smoothly contoured nuclei,

small nucleoli and fragile frayed cytoplasmic edges. 60x

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

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

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

MALIGNANT: ADRENAL GLAND (FNA)

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

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

Adrenal gland, Metastatic small cell carcinoma60x

Adrenal gland, Metastatic small cell carcinoma

60x

Adrenal gland, Metastatic adenocarcinomaProminent 3-D cell ball formation without intercellular

windows indicating glandular differentiation.60x

Adrenal gland, Metastatic adenocarcinoma60x

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

14) OVARY

BENIGNSerous 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

Serous cystadenoma and cystadenofibroma

Cytomorphology:

Cuboidal cells

Ciliated cells

Detached ciliary tufts

Psammoma bodies (rare)

Mucinous cystadenoma

Cytomorphology:

Mucinous cells

Isolated cells, ribbons, sheets

Macrophages

Extracellular mucin

BENIGN EPITHELIAL NEOPLASMS

Serous cystadenoma. Benign ciliated cells have basally placed nuclei, terminal bars, and cilia.

Mucinous cystadenoma. Among the macrophages are fragments of benign mucinous epithelium endocervial epithelium.

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

Cytomorphology: serous cystadenocarcinoma

Cluster and isolated cells

Large pleomorphic cells

Round nuclei

Prominent nucleoli

Psammoma bodies

MALIGNANT EPITHELIAL NEOPLASMS

Serous of low malignant potential tumor. The cells are arranged in a crowded sheet. There is mild to meoderate atypia.

In this tight spherical aggregate, some cells have large cytoplasmic vacuoles

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

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

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

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 NEOPLASMSLEIOMYOSARCOMASCHWANNOMA

ROUND CELL NEOPLASMDESMOPLASTIC SMALL ROUND CELL

TUMORALVEOLAR RHABDOMYOSARCOMA

CONTENTS

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)

SPINDLE CELL NEOPLASMS

LEIOMYOSARCOMA

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)

SCHWANNOMA

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

DESMOPLASTIC SMALL ROUND CELL TUMOR

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)

ALVEOLAR RHABDOMYOSARCOMA

ROUND CELL NEOPLASM