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Pleura Cytology
- 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