* <spoiler text="What ancillary tests would you recommend?">For this patient, we recommended that the radiologist perform a biopsy of the lesion so that it could be sent for immunohistochemical workup. Since the overall percentage of the atypical cells were low, we were worried that a cell block would not contain enough of the malignant cells for additional stains. We also sent the lymph node for flow since a hematologic malignancy was suspected; however, with Hodgkin lymphoma, we don't expect any diagnostic findings from flow cytometry.</spoiler>
===Biopsy===
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20131111Biopsy1.jpg|This is a 2x magnification the biopsy specimen from the spinal mass. We see that this is bone histology which is abnormal. There is an increase in cellularity, especially for an 80 year old person.
CytologicallyYoursCoW20131111Biopsy2.jpg|This is a 4x magnification of the biopsy specimen from the spinal mass. We can see that there is an increase in cellularity.
CytologicallyYoursCoW20131111Biopsy3.jpg|This is a 20x magnification of the biopsy specimen from the spinal mass. This is one of the areas that has increased cellularity on lower power. We can see cells forming what appear to be glands in the bone marrow.
CytologicallyYoursCoW20131111Biopsy4.jpg|This is a 20x magnification of the biopsy specimen from the spinal mass. Here we see well formed glands in the bone marrow.
CytologicallyYoursCoW20131111Biopsy5.jpg|This is a 60x magnification of the biopsy specimen from the spinal mass. The malignant cells appear to be creating glandular structures, and we can identify prominent nucleoli in the malignant cells.
CytologicallyYoursCoW20131111Biopsy6.jpg|This is a 60x magnification of the biopsy specimen from the spinal mass. Again we see well formed glands in the bone marrow, made of cells that have prominent nucleoli.
</gallery>
====Immunohistochemistry====
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20131111Biopsy7.jpg|PSA, 2x magnification. Note the predominance of brown staining in the middle.
CytologicallyYoursCoW20131111Biopsy8.jpg|PSA, 60x magnification. The glands are highlighted in brown, and on the upper right the blood vessels are negative.
</gallery>
=====Resident Questions=====
* <spoiler text="If you could only have one stain, what stain would it be?">
This is a male patient with a new spinal mass. The spinal mass has glands made of cells with prominent nucleoli. In a case like this you should consider prostate as the source of the malignancy. A PSA stain would help highlight cells of prostatic origin.
</spoiler>
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