Cytologically Yours: CoW: 20140113

Clinical Summary

The patient is a 69 year old female with a new mass in the right pulmonary hilum.

Past Medical History

• Hyperlipidemia
• Osteoporosis
• Chronic obstructive pulmonary disease
• Hepatitis
• Smoker (1 pack per day for 40 years, quit in 2002)

Past Surgical History

• Hysterectomy (1975)
• Hernia repair (1992)
• Cardiac catheterization (2002)
• Lumbarsacral discectomy (2008)
• Lumbarsacral fusion with rod placement (2013)

CT

• 4.8 x 3.1 cm mass in the right hilum.
• 4.4 x 1.5 cm nodular densityin the right upper lobe.
• 1.5 cm enlarged paratracheal lymph node.

• CT with contrast: mass in the right hilum extends into the mediastium and the SVC is compressed.

Clinical Plan

Bronchoscopy for furhter evaluation.

Pathology

Cytology

• 
  10x magnification of a cellular specimen.(DQ)
• 
  40x magnification showing cohesive groups of atypical cells adjacent to bronchial cells. (DQ)
• 
  40x magnification showing a large group of cohesive cells that are molding upon one another. (DQ)
• 
  40x magnification showing cells that are molding and forming a row of cells.(DQ)
• 
  20x magnification of cells with chromatin that looks punctate.(pap)
• 
  60x magnification of cells with punctate chromatin and molding.(pap)

Resident Questions

• What was the initial diagnosis on rapid interpretation?

Positive for malignancy.

• What stains would you order?

CD56, Synaptophysin, Chromogranin, TTF-1

Click here to toggle the diagnosis and discussion.

Final Diagnosis

Cytology

• Small Cell Carcinoma.

Discussion

Small cell carcinoma is associated with smoking and is generally a central lesion that arises in larger airways. Small cell carcinoma is prone to central necrosis and radiologically this may be seen.