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===Cytology===
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CytologicallyYoursCoW20131216Cytology1.jpg|4x 10x magnification of a 4R lymph nodepleural fluid(ThinPrep). Groups of cohesive epithelial appearing cells can be are seen on low power. Lymphoid tissue is not easily identified.CytologicallyYoursCoW20131216Cytology2.jpg|20x 40x magnification of a 4R lymph nodepleural fluid (ThinPrep). This is a cellular specimen with groups Cluster of atypical cells along what appear to be a papillary or papillary-like structure. Single cells are also dispersed in the background. The cells are haphazardly arrangedshowing nuclear pleomorphism and scant cytoplasm.CytologicallyYoursCoW20131216Cytology3.jpg|40x magnification of a 4R lymph nodepleural fluid (ThinPrep). On higher power, the nuclei appear mildly atypical Chromatin is irregular and the cytoplasm is delicate clumped with salt and finely vacuolated. The nuclear contours pepper appearance; although, occasional nucleoli are somewhat irregularalso seen.CytologicallyYoursCoW20131216Cytology4.jpg|Cell block 40x magnification of 4R lymph nodepleural fluid (ThinPrep). The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypicalSome nuclear molding can be appreciated and a mitotic figure is present. CytologicallyYoursCoW20131216Cytology5.jpg|Cell block of 4R lymph nodepleural fluid. The Group of malignant cells showing nuclear molding, scant cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei and salt and pepper chromatin. Nucleoli are relatively uniform, but somewhat atypicalalso seen.
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====Resident QuestionsOther immunostains performed====* <spoiler text="What are other immunohistochemical stains that would be applicable in this case?">BerEp4 Positive* Moc31 Faintly positive* Calretinin Negative* RCCTTF1 Negative*CD10Chromogranin Positive*PAX2Synaptophysin Positive*Kidney specific antigenCD56 Positive</spoiler>* Napsin A Negative
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==Final Diagnosis==
===Cytology===
* Rapid diagnosis: Non-small Small cell carcinoma.* Final diagnosis: Renal cell carcinoma.
===Discussion===
The differential diagnosis includes large cell neuroendocrine carcinoma, and possibly nonkeratinizing squamous cell carcinoma and adenocarcinoma. In this case, we know that we are dealing with a poorly differentiated neuroendocrine carcinoma based on immunohistochemistry. In addition, except for the occasional nucleoli, this lesion has all of the features of a small cell carcinoma (scant cytoplasm, nuclear molding). In this case, the possibility of a poorly differentiated carcinoma with mixed large cell and small cell features may not be able to be completely ruled out on cytology of the pleural fluid. It has been determined that prominent nucleoli may be seen in small cell carcinomas up to 24% of the time (Khalbuss WE The cytomorphologic spectrum of small-cell carcinoma and large-cell neuroendocrine carcinoma in body cavity effusions: A study of 68 cases. CytoJournal 2011, 8:18. [[http://www.cytojournal.com/article.asp?issn=1742-6413;year=2011;volume=8;issue=1;spage=18;epage=18;aulast=Khalbuss]]
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