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===Clinical Plan===
The concern is a primary renal malignancy with metastatic disease to lungs. An endobronchial ultrasound guided FNA is scheduled. An onsite rapid diagnosis by cytology was scheduled.
==Radiology==
CytologicallyYoursCoW20131209Cytology3.jpg|40x magnification of a 4R lymph node. On higher power, the nuclei appear mildly atypical and the cytoplasm is delicate and finely vacuolated.
CytologicallyYoursCoW20131209Cytology4.jpg|Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform and monotonous.
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===Immunohistochemistry===
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CytologicallyYoursCoW20131209Cytology5.jpg|PAX8 on 4R lymph node shows positive nuclear staining.
==Final Diagnosis==
===Cytology===
* '''Positive for malignancy, the differential Rapid diagnosis includes melanoma and Hodgkin lymphoma''': Non-small cell carcinoma.* Final diagnosis: Renal cell carcinoma.
==Case Discussion==