1. Cytopathology Challenge! Weekly Cases October 15th 2007

2. 34 year old female. ThinPrep pap A.Hyperkeratosis B.Parakeratosis C.ASCUS D.LSIL E.HSIL

3. 66 year old male with enlarged neck node. FNA specimen A.Reactive B.Suspicious C.Positive for tumor D.Artifact E.Send for flow……

4. 56 year old male with common bile duct stricture. Brushing. A.Normal B.Reactive C.Suspicious D.Positive for tumor E.Artifact

5. 24 year old female. ThinPrep pap A.Reactive B.ASCUS C.LSIL D.HSIL E.AGC

6. 52 year old female with submucosal gastric mass FNA. Which of the following stains would be most helpful? A.Vimentin B.CDX-2 C.Mucin D.CD-117 E.CK7/CK20

7. 59 year old male with livr lesion and hx of melanoma. FNA. A.Adenocarcinoma B.Squamous cell carcinoma C.Neuroendocrine tumor D.Metastatic melanoma E.Benign epithelium

8. 28 year old female. ThinPrep pap A.Reactive endocervical cells B.ASCUS C.LSIL D.HSIL E.AGC

9. 37 year old female. Thyroid FNA A.Hashimoto’s thyroiditis B.Hurthle cell change C.Follicular carcinoma D.Papillary carcinoma E.Medullary carcinoma

10. 66 year old male with lung lesions. FNA. A.Reactive endobronchial cells B.Germinal center cells C.Neuroendocrine tumor D.Bronchioloalveolar carcinoma (BAC) E.Non-small cell carcinoma

11. 58 year old male with psoas mass and hx of Hep C. FNA cell block. A.Hepatocellular carcinoma B.Skeletal muscle C.Epithelioid histocytes D.Renal cell carcinoma E.Rhabdomyoma

12. Answers 1.A Hyperkeratosis Nucleus has disappeared 2.C Metastatic squamous cell carcinoma Patient had throat primary 3.D Positive for tumor Big cells with irregular nuclei 4.C LSIL Koilocytes 5.D CD-117 Spindle cell lesion in GI tract – rule out GastroIntestinal Stromal Tumor (GIST). 6.C Neuroendocrine tumor Big salt and pepper cells – could be melanoma, but no inclusions and not too discohesive (tough differential though – we did get a S-100 that was negative and Chromogranin/Synaptophysin+) 7.D HSIL NC ratio is increased. Nuclei irregular. Biopsy subsequently had CIN 3. 8.D Papillary thyroid carcinoma See the pseudoinclusion……. 9.E Non-small cell lung carcinoma 10.A Metastatic Hepatocellular Carcinoma Subsequently confirmed with Hep-Par 1