Cytopathology Case Revie › media › samplechapters › 978162070059…Cytopathology Case Review Christopher J. VandenBussChe • syed Z. ali Christopher J. VandenBussche, MD, PhD

Cytopathology Case Review

Christopher J. VandenBussChe • syed Z. ali

Christopher J. VandenBussche, MD, PhD syed Z. ali, Md, FrCpath, FiaC

Cytopathology Case Review

Pathology residents, fellows, and practitioners will welcome this cytopathology review of carefully selected case scenarios drawn from the Johns Hopkins case archive. Each illustrated case scenario contains multiple choice questions along with detailed explanations and references in an ideal format for review or self-assessment of diagnostic skills and decision-making.

Authored by distinguished faculty at Johns Hopkins University, the review covers all major topics within cytopathology. Each clinical case scenario includes representative images and clinical history, diagnostic question, and detailed discussion supported by thoughtfully selected key references. Cases are presented in random order to maximize their teaching and review value. Additionally, a case and topic index is included so that users can access the content by a specific topic or diagnosis.

Key Features:■■ Contains questions based on carefully selected, illustrated case scenarios drawn from the Johns Hopkins case archive

■■ Includes 125 multiple choice questions covering all major cytopathology topics with detailed explanations and references

■■ Facilitates self-assessment, review and diagnostic problem-solving with 500 high-quality images

■■ Includes clinical and imaging correlations in case scenarios

■■ Provides access to questions in random order or by specific method or site

Recommended Shelving Category

Pathology

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Visit This Book’s Web Page / Buy Now / Request an Exam/Review CopyThis is a sample from Cytopathology Case Review

© Demos Medical Publishing

CYTOPATHOLOGY CASE REVIEW

http://www.demosmedical.com/catalogsearch/result/?q=9781620700594






NEW YORK


Christopher J. VandenBussche, MD, PhDAssistant Professor of PathologyThe Johns Hopkins HospitalBaltimore, Maryland

Syed Z. Ali, MD, FRCPath, FIACProfessor of Pathology and RadiologyThe Johns Hopkins HospitalBaltimore, Maryland




Visit our website at www.demosmedical.com

ISBN: 9781620700594e-book ISBN: 9781617052224

Acquisitions Editor: Rich WintersCompositor: Exeter Premedia Services Private Ltd.

© 2015 Demos Medical Publishing, LLC. All rights reserved. Th is book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. Th e authors, editors, and publisher have made every eff ort to ensure that all information in this book is in accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omis-sions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contra-indications stated by the manufacturer diff er from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market.

Library of Congress Cataloging-in-Publication DataVandenBussche, Christopher J., author.Cytopathology case review / Christopher J. VandenBussche and Syed Z. Ali. p. ; cm.Includes bibliographical references. ISBN 978-1-62070-059-4—ISBN 978-1-61705-222-4 (e-book) I. Ali, Syed Z., author. II. Title. [DNLM: 1. Cytodiagnosis—Case Reports. 2. Pathology, Clinical—Case Reports. QY 95] RB43 616.07’582—dc23 2014038358

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Th is book is dedicated to all our past, current, and future trainees, the major driving force behind this project.

Christopher J. VandenBusscheSyed Z. Ali







CONTENTS vii

CONTENTS

Foreword Michael R. Henry, MD xiPreface xiii

Case Number Sampling Method Anatomic Site1 Fluid Pericardium 12 FNA Th yroid 33 Pap test Cervix 54 Fluid Abdomen 75 FNA Lymph node 96 FNA Breast 117 Urine Bladder 138 FNA Lung 159 FNA Liver 17

10 FNA Pleura 1911 FNA Bone 2112 Pap test Cervix 2313 FNA Stomach 2514 FNA Pancreas 2715 FNA Soft tissue 2916 FNA Salivary 3117 FNA Liver 3318 FNA Th yroid 3519 FNA Soft tissue 3720 FNA Salivary 3921 FNA Pleura 4122 FNA Salivary 4323 Fluid Ovarian cyst 4524 FNA Lung 4725 FNA Salivary 4926 FNA Lung 51




viii CONTENTS

Case Number Sampling Method Anatomic Site27 FNA Brain 5328 FNA Salivary 5529 FNA Soft tissue 5730 FNA Adrenal 5931 FNA Bone 6132 FNA Soft tissue 6333 FNA Soft tissue 6534 FNA Lymph node 6735 FNA Lymph node 6936 FNA Soft tissue 7137 FNA Th yroid 7338 FNA Liver 7539 FNA Soft tissue 7740 Brushing Pancreas 7941 FNA Lung 8142 Fluid Paracentesis 8343 FNA Scrotum 8544 FNA Breast 8745 FNA Mediastinum 8946 FNA Mediastinum 9147 FNA Kidney 9348 FNA Liver 9549 FNA Liver 9750 FNA Lymph node 9951 FNA Soft tissue 10152 FNA Soft tissue 10353 FNA CNS 10554 FNA Breast 10755 FNA Ovary 10956 Fluid CSF 11157 FNA Th yroid 11358 FNA Neck 11559 FNA Salivary 11760 FNA Breast 11961 Pap test Cervix 12162 BAL Lung 12363 FNA Kidney 125




CONTENTS ix

Case Number Sampling Method Anatomic Site64 FNA Th yroid 12765 Pap test Cervix 12966 Pap test Cervix 13167 FNA Pancreas 13368 FNA Lung 13569 FNA Soft tissue 13770 FNA Liver 13971 Pap test Vagina 14172 FNA Pancreas 14373 Fluid CSF 14574 FNA Brain 14775 Pap test Vagina 14976 FNA Kidney 15177 FNA Salivary 15378 FNA Th yroid 15579 FNA Soft tissue 15780 FNA Salivary 15981 Fluid CSF 16182 FNA Soft tissue 16383 FNA Bone 16584 FNA Liver 16785 FNA Soft tissue 16986 FNA Soft tissue 17187 FNA Liver 17388 FNA Soft tissue 17589 Pap test Uterus 17790 FNA Soft tissue 17991 FNA Pancreas 18192 FNA Soft tissue 18393 FNA Th yroid 18594 FNA Th yroid 18795 FNA Bone 18996 FNA Th yroid 19197 FNA Soft tissue 19398 FNA Liver 19599 Urine Bladder 197

100 Pap test Cervix 199




x CONTENTS

Case Number Sampling Method Anatomic Site101 Pap test Anus 201102 FNA Liver 203103 FNA Lymph node 205104 FNA Th yroid 207105 FNA Mediastinum 209106 FNA Lung 211107 FNA Soft tissue 213108 FNA Th yroid 215109 FNA Pancreas 217110 FNA Soft tissue 219111 FNA Th yroid 221112 FNA Liver 223113 Urine Neobladder 225114 FNA Lung 227115 FNA Soft tissue 229116 FNA Salivary 231117 FNA Liver 233118 FNA Pancreas 235119 FNA Breast 237120 Fluid Peritoneum 239121 FNA Liver 241122 FNA Bone 243123 FNA Soft tissue 245124 FNA Soft tissue 247125 FNA Soft tissue 249Index by Case Diagnosis 251Index by Case Topic 253




FOREWORD xi

FOREWORD

As the fi eld of cytopathology becomes more complex and testing of cytologic specimens extends into the molecular realm it becomes even more important to recognize the diff er-ential diagnoses that derive from the basic morphology of the cytologic sample. Cytopathol-ogy Case Review allows the reader to delve into the case fi les of the John Hopkins University cytology department and explore the morphology and review the diagnostic possibilities. Th e book will be welcomed by pathology residents and fellows, cytotechnology students as well as practicing pathologists and cytotechnologists. Doctors VandenBussche and Ali share their experience and expertise in a fashion that is enjoyable and educational. Th e breadth of cases seen at their institution as illustrated by these cases makes the book useful for students as well as experienced cytopathologists.

Th e 125 cases which are presented in the following pages cover the entire gamut of cytol-ogy with representative cases from fl uids, exfoliative cytology and fi ne needle aspirations. Th e cases are arranged in a random fashion in order to maximize the teaching value but may also be accessed by the sample site or type of preparation. Each case is illustrated to highlight the important cytologic features and is followed by a short pertinent history and list of potential diagnoses. On the next page is the answer with explanation and key refer-ences. Th ese short presentations allow the reader to spend as little or as long as they wish browsing the cases and provides an easy way to review morphology or test their knowledge.

I thoroughly enjoyed sampling these cases and know that they will be of use now and well into the future.

Michael R. Henry, MDDirector of Cytopathology

Department of Laboratory MedicineMayo Clinic

Rochester, Minnesota







PREFACE xiii

PREFACE

Th e fi eld of cytopathology, while related to other fi elds of anatomic pathology, is rooted in its own fundamentals. While cytopathologic and histopathologic fi ndings can oft en be cor-related, some features found in cytologic material are absent on histology, just as histology can provide information not found in cytology. Th e cases presented here are intended to help focus the reader’s attention on the most important cytomorphological fi ndings.

In many instances, the images shown may suggest several possible diagnostic scenarios and the reader must choose the best answer based on limited information. Th is challenge is not meant to frustrate the reader, but rather to hone attention to particular fi ndings. Th is format is also commonly found on standardized pathology examinations.

Regardless of whether the reader is a pathologist or cytotechnologist, a trainee may learn most from the case discussions while the more advanced reader may use the cases to test their knowledge. Th e readers who benefi t most will be those who critically study the case images, and not necessarily the readers who answer the most questions correctly.

Several of these cases illustrated herein were modifi ed from Th e Johns Hopkins Web Case Conference. We would like to acknowledge and thank Dr. Douglas P. Clark for his role as past editor of the Web Case Conference, as well as our numerous trainees that contrib-uted cases to the conference over the years. We invite readers who enjoy these cases to par-ticipate in an updated version of the Web Case Conference, now titled “Case of the Week” and linked through our division Web page (http://pathology.jhu.edu/cytopath).

All proceedings from this book will be contributed to a cytopathology fellowship fund for education and research.

Christopher J. VandenBusscheSyed Z. Ali

http://pathology.jhu.edu/cytopath














CASE 1 1

CASE

Clinical HistoryPericardial fl uid in a 30-year-old male with a history of a malignant neoplasm.

Choose the Best Diagnosisa. Metastatic adenocarcinoma

b. Hodgkin lymphoma

c. Reactive mesothelial cells

d. Large cell lymphoma

e. Melanoma

1




2 CYTOPATHOLOGY CASE REVIEW

ANSWER AND BRIEF DISCUSSION

b. Hodgkin LymphomaTh is is a cellular specimen containing three populations of cells. Th e specimen consists predominantly of fl oridly reactive mesothelial cells with focal papillary formations. In addi-tion, there are numerous small round lymphocytes in the background. Th e third population consists of rare, scattered, large atypical cells with abundant cytoplasm, markedly enlarged nuclei, and macronucleoli. Occasionally, these atypical cells are binucleated.

Without ancillary studies, the diff erential diagnosis for these large atypical cells is broad. Given the fl orid mesothelial proliferation, one must consider reactive mesothelial cells. However, the cells in question are distinctly larger and have a diff erent appearance of the chromatin than the reactive mesothelial cells. A poorly diff erentiated adenocarcinoma could certainly present in this fashion as well and is the most common malignancy seen in an eff usion sample. Th e clinical history is defi nitely helpful in this patient. Th is patient has a long history of Hodgkin lymphoma with multiple recurrences, most recently in the liver. Th e histology of the liver biopsy revealed the typical mixed lymphocytic infi ltrate of Hodgkin lymphoma containing large Reed-Sternberg cells.

References1. Das DK. Serous effusions in malignant lymphomas: a review. Diagn Cytopathol. 2006;34(5):

335–347.2. McDonnell PJ, Mann RB, Bulkley BH. Involvement of the heart by malignant lymphoma: a clini-

copathologic study. Cancer. 1982;49(5):944–951.


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Cytopathology Case Revie › media › samplechapters › 978162070059…Cytopathology Case Review Christopher J. VandenBussChe • syed Z. ali Christopher J. VandenBussche, MD, PhD