1. Interesting Case - Cytology
Dr Tamil Nila M

2. Case History
A 43 year old male came with complaints of Anterior chest wall
swelling that was rapidly progressing in size for the past 1.5 months

5. Radiology report
• Large pleural based mass lesion measuring 12 x 10 cm in the right
chest wall
• Compression of the right lung with erosion of 2nd , 3rd and 4th ribs.
• Impression:
• Picture of Mesothelioma

6. FNAC

8. Microscopy
• Smears studied show scattered and clusters of pleomorphic
plasmacytoid cells with eccentrically placed nucleus in a
haemorrhagic background
• Smears positive for malignancy
• Kindly do tissue biopsy for confirmation and further evaluation

9. DD – Pleural based lesions
• Mesothelioma
• Solitary fibrous Tumour
• Plasmacytoma
• Metastases

10. Mesothelial cells
• Single & small clusters
• Uniform
• Window
• Round cells
• Round, central/eccentrically
placed nuclei
• Prominent nucleoli
• Well defined cytoplasmic border
• Cytoplasmic blebs
Cytochemistry
Alcian Blue
PAS
Immunocytochemistry
Calretinin

11. Mesothelioma
• Pattern
• Spherical clusters with knobby edges
• Papillae like clusters
• Dissociated cells
• Cell in cell (cannibalism)
• Mesothelial cell morphology
• Enlarged cells
• Low N:C Ratio
• Binucleation/ Multinucleation
• Centrally placed nucleus with large prominent nucleoli (macronucleoli)
• Condensed cytoplasm with ring-like peripheral clear zone

12. Solitary fibrous tumour
• Bloody aspirate
• Oval to elongated spindle cells
• Short fascicles
• Scanty cytoplasm
• Elongated spindle-shaped nucleus with pointed ends
• Reticular nuclear chromatin
• Naked nuclei and ropy collagen in the background

13. Plasmacytoma
• Many plasma cells
• Uniformly dispersed
• Single cell presentation
• Variable cell differentiation

14. Metastases
Male Female
Lung
Hematological malignancy
Gastrointestinal Malignancy
Breast
Lung
Gynecological
GIT

15. Malignant cells - Features
• Cell Arrangement
• Cannon ball-like tight 3D clusters
• Papillary clusters
• Single (Small cell Ca lung)
• Small rows (Lobular Ca Breast)
• Cytoplasm
• Vacuolated
• Keratin (SCC)
• Mucous (Adeno Carcinoma)
• Melanin (Melanoma)

16. Malignant cells – features
• Nucleus
• High N:C ratio
• Large
• Plemorphic
• Irregular nuclear margin
• Prominent nucleoli
• Coarse chromatin
• Mitosis
• Tripolar mitosis
• Cannibalism
• Psammoma bodies

17. Squamous cell carcinoma
• Small clusters / discrete cell population
• Keratinising SCC – Polyhedral Cells
• Non Keratinising SCC – Oval cells
• Cytoplasm: Dense & Orangeophilic
• Nucleus: Hyperchromatic
• Inconspicuous nucleoli
• Cytoplasmic Vacuoles – Degenerative changes

18. Adenocarcinoma
• Two cell population
• Tight spherical ball like clusters of cells
• Nuclear overlappin & Crowding
• Cell Cannibalism
• Bi or Multinucleation present
• Prominent nucleoli
• Vacuolated cytoplasm

19. Small cell lung carcinoma
• Arrangement: Small clusters/ Discrete/ Small
Chains
• 2 X Diameter of Lymphocyte
• Scanty Cytoplasm
• Nuclear molding/ Angulations
• Granular chromatin
• Inconspicous Nucleoli

20. References
• Bibbo M., Wilbur D. Comprehensive Cytopathology .2015
• Orell and sterretts Fine needle aspiration cytology, 5th-edition
• Diagnostic Cytology, Pranab dey
• Atlas of Serous Fluid Cytopathology, Arthur I Spriggs