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CytologicallyYoursCoW20131216Cytology1.jpg|10x magnification of pleural fluid(ThinPrep). Groups of cohesive epithelial appearing cells are seen on low power.
CytologicallyYoursCoW20131216Cytology2.jpg|40x magnification of pleural fluid (ThinPrep). Cluster of atypical cells showing nuclear pleomorphism and scant cytoplasm.
CytologicallyYoursCoW20131216Cytology3.jpg|40x magnification of pleural fluid (ThinPrep). Chromatin is irregular and clumped with salt and pepper appearance; although, occasional nucleoli are also seen.CytologicallyYoursCoW20131216Cytology4.jpg|40x magnification of pleural fluid (ThinPrep). Some nuclear molding can be appreciatedand a mitotic figure is present. CytologicallyYoursCoW20131216Cytology5.jpg|Cell block of pleural fluid. Group of malignant cells showing nuclear molding, scant cytoplasm, and salt and pepper chromatin. Nucleoli are also 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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