Cytologically Yours: Unknowns: 201310: Case 2

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Contents

Clinical History

55 year old male with a right upper lobe lung mass and mediastinal adenopathy. The patient is a smoker.

Cytology

Resident Questions


Additional Teaching Points

Differential Diagnosis

  • Follicular bronchitis
    • Polymorphic lymphocytic population
    • Follicular centers
    • Tingible body macrophages
    • Plasma cells
  • Reactive bronchial cells
    • Round/cuboidal (en face) columnar (on profile)
    • Smooth nuclear membranes
    • Fine granular chromatin
    • No nuclear molding
  • Carcinoid
    • Cells will be in loosely cohesive groups or in tissue fragments, in cords, nests, ribbons, or acinar pattern
    • Cells will be uniform small round with round/oeal smooth nuclear membrane
    • Salt and pepper chromatin
    • +/- Nucleoli
    • No molding
    • + Neuroendocrine markers, + Cytokeratin, + CEA
  • Large Neuroendocrine Carcinoma
    • Isolated cells or loosely cohesive groups
    • Variable cell size and cytoplasm
    • High N/C
    • Round nuclei
    • Coarsely granular cytoplasm
    • Frequent nucleoli
    • Nuclear molding