Clinical History
55 year old male with a right upper lobe lung mass and mediastinal adenopathy.
The patient is a smoker.
Cytology
Resident Questions
- Small Cell Carcinoma
- 12-18% of all lung cancers
- Age range 32-79 years
- Males > Females
- Association with smoking
Most are metastatic at diagnosis, therefore not resectable.
- CD56
- Synaptophysin
- Chromogranin
- Neuron Specific Enolase (NSE)
- Pancytokeratin (dot like staining)
- Thyroid Transcription Factor-1 (TTF-1)
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
