Morphology Quiz: Pleural Effusion Case history See images pages 65, 66. • 62-year-old male • History of colon cancer with liver metastases (2 years ago) • Now presenting with a right pleural effusion
Question 1 Based on the images provided on the following page, what is the likely cytological diagnosis? A. No malignant cells
D. BRAF V600E mutation E. PIK3CA mutation Question 4 List five cytological features of malignant mesothelioma in a serous effusion: 1: _______________________ 2: _______________________ 3: _______________________ 4: _______________________ 5: _______________________
B. Adenocarcinoma of lung primary
Question 5
C. Reactive mesothelial cells
List the variants of malignant mesothelioma 1: _______________________ 2: _______________________ 3: _______________________ 4: _______________________
D. Metastatic adenocarcinoma of the colon E. Malignant mesothelioma Question 2 The two most diagnostically useful immunocytochemical stains for distinguishing benign from malignant mesothelial cells are: A. MOC 31 and Desmin B. Desmin and EMA C. EMA and CK 5/6 D. D2-40 and CK 5/6 E. D2-40 and MOC 31
Answers on page 67
Recommended reading 1. De May R. The Art and Science of Cytopathology. Chicago: ASCP; 268–372. 2. Shidham VB, Falzon M. Serous effusions. In: Diagnostic Cytopathology, 3rd edn. Gray W, Kocjan G (eds). London: Churchill Livingstone; 2010: pp. 115–75.
Question 3 The most diagnostically useful molecular marker to confirm a diagnosis of malignant mesothelioma is: A. p16/CDKN2A deletion B. EGFR mutation C. EML4-ALK translocation
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CYT_12241.indd 64
DOI:10.1111/cyt.12241 Durgesh N. Rana* and Nadira Narine
Central Manchester University Hospitals NHS Foundation Trust Oxford Road, Manchester, M13 9WL, UK *email: [email protected] (for correspondence)
© 2015 John Wiley & Sons Ltd Cytopathology 2015, 26, 64–67
2/3/2015 1:05:33 PM
Figure 1. Numerous three dimensional clusters of cells.
Figure 5. Hyalinised stroma present.
Figure 2. Numerous three dimensional and occasional papillary clusters of cells.
Figure 6. Agar cell block.
Figure 3. Cluster of cells with two tone appearance.
Figure 7. AE1/AE3.
Figure 4. Clusters of cells with scalloped borders.
Figure 8. MOC 31.
© 2015 John Wiley & Sons Ltd Cytopathology 2015, 26, 64–67
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Figure 9. CDX2.
Figure 13. Desmin.
Figure 10. TTF-1 and Napsin A.
Figure 14. EMA.
Figure 11. D2-40.
Figure 15. p53.
Figure 12. CK5/6.
Figure 16. FISH.
© 2015 John Wiley & Sons Ltd Cytopathology 2015, 26, 64–67
2/3/2015 1:05:36 PM
Answers to Morphology Quiz: Pages 64–66 Question 1 Answer: E. Question 2 Answer: B.
• • • • • •
Cytomegaly – larger cells and bigger clusters. N/C ratios relatively constant. Round, centrally placed nucleus. Prominent nucleoli. Binucleation and multinucleation. Dense cytoplasm with pale rim.
Question 3
Question 5
Answer: A.
Answer:
Question 4
1. 2. 3. 4.
Answer: • •
Marked cellularity. Clusters with scalloped contours.
© 2015 John Wiley & Sons Ltd Cytopathology 2015, 26, 64–67
CYT_12241.indd 67
Epithelioid. Sarcomatoid. Biphasic. Desmoplastic.
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Question 1 Based on the images provided on the following page, what is the likely cytological diagnosis? A. No malignant cells
D. BRAF V600E mutation E. PIK3CA mutation Question 4 List five cytological features of malignant mesothelioma in a serous effusion: 1: _______________________ 2: _______________________ 3: _______________________ 4: _______________________ 5: _______________________
B. Adenocarcinoma of lung primary
Question 5
C. Reactive mesothelial cells
List the variants of malignant mesothelioma 1: _______________________ 2: _______________________ 3: _______________________ 4: _______________________
D. Metastatic adenocarcinoma of the colon E. Malignant mesothelioma Question 2 The two most diagnostically useful immunocytochemical stains for distinguishing benign from malignant mesothelial cells are: A. MOC 31 and Desmin B. Desmin and EMA C. EMA and CK 5/6 D. D2-40 and CK 5/6 E. D2-40 and MOC 31
Answers on page 67
Recommended reading 1. De May R. The Art and Science of Cytopathology. Chicago: ASCP; 268–372. 2. Shidham VB, Falzon M. Serous effusions. In: Diagnostic Cytopathology, 3rd edn. Gray W, Kocjan G (eds). London: Churchill Livingstone; 2010: pp. 115–75.
Question 3 The most diagnostically useful molecular marker to confirm a diagnosis of malignant mesothelioma is: A. p16/CDKN2A deletion B. EGFR mutation C. EML4-ALK translocation
64
CYT_12241.indd 64
DOI:10.1111/cyt.12241 Durgesh N. Rana* and Nadira Narine
Central Manchester University Hospitals NHS Foundation Trust Oxford Road, Manchester, M13 9WL, UK *email: [email protected] (for correspondence)
© 2015 John Wiley & Sons Ltd Cytopathology 2015, 26, 64–67
2/3/2015 1:05:33 PM
Figure 1. Numerous three dimensional clusters of cells.
Figure 5. Hyalinised stroma present.
Figure 2. Numerous three dimensional and occasional papillary clusters of cells.
Figure 6. Agar cell block.
Figure 3. Cluster of cells with two tone appearance.
Figure 7. AE1/AE3.
Figure 4. Clusters of cells with scalloped borders.
Figure 8. MOC 31.
© 2015 John Wiley & Sons Ltd Cytopathology 2015, 26, 64–67
CYT_12241.indd 65
65
2/3/2015 1:05:33 PM
66
CYT_12241.indd 66
Figure 9. CDX2.
Figure 13. Desmin.
Figure 10. TTF-1 and Napsin A.
Figure 14. EMA.
Figure 11. D2-40.
Figure 15. p53.
Figure 12. CK5/6.
Figure 16. FISH.
© 2015 John Wiley & Sons Ltd Cytopathology 2015, 26, 64–67
2/3/2015 1:05:36 PM
Answers to Morphology Quiz: Pages 64–66 Question 1 Answer: E. Question 2 Answer: B.
• • • • • •
Cytomegaly – larger cells and bigger clusters. N/C ratios relatively constant. Round, centrally placed nucleus. Prominent nucleoli. Binucleation and multinucleation. Dense cytoplasm with pale rim.
Question 3
Question 5
Answer: A.
Answer:
Question 4
1. 2. 3. 4.
Answer: • •
Marked cellularity. Clusters with scalloped contours.
© 2015 John Wiley & Sons Ltd Cytopathology 2015, 26, 64–67
CYT_12241.indd 67
Epithelioid. Sarcomatoid. Biphasic. Desmoplastic.
67
2/3/2015 1:05:39 PM
