Unusual andunfected findings on clinical specimens submitted for cytopathological diagnosis.

1. There’s more to Cytology than
meets the Eye
 Genevieve Warner Learmonth

2. When screening a slide, note carefully what
you observe, no matter how odd it may seem,
Before you make up your mind,OPEN IT!
There’s a bone in her mouth!
But isn’t a giraffe herbivorous?

3. Cervical smear, age 40
Screening programme
Primary screener: “carbon laden macrophages”
Or is it melanin?

4. Patient referred for Colposcopy
& Biopsy
Histopathology: malignant
Brown lesion on ectocervix melanoma

5. FNA Breast: on - site breast clinic
 Screener phoned
me and described
“smear is black. I
think I can see
carbon laden
macrophages”.
 The aspirate looks
like liquorice !”

6. Slides referred via vacuum tube
direct to Cytology Laboratory

7. Cytology comment was queried
by senior colleagues ,so the
mass was excised,
Histological
findings --- probable lymph
node relpaced by diffuse
fibrosis and anthracosis. No
lypmhoid tissue remaining.
No epithelial cells present.
Conclusion: Hut Breast

8. Further Enquiry
 The female patient was admitted to hospital
for investigation of dyspnoea ? TB.
 Chest Xray showed diffuse fibrosis
 ? Pneumoconiosis.
 The mass in the upper outer quadrant of the
breast was an incidental finding !!
 Patient was sent to the breast Clinic

9. Hut dweller from Transkei, inhalation of smoke
in huts, termed “hut Lung” Prof Bateman ( GSH
1992). Mediastinal lymphatics are overwhelmed
with carbon. Intramammary nodes involved as
well as neck nodes.

10. FNA Mass in Right lower lobe of
Lung, female 32yrs old.
Cytology
Review
Primary screener: “highly
atypical cells”.
Plentiful cytoplasm
Round nuclei
?Bronchiolar alveolar carcinoma?
Correlate with Chest Xray in view
of age.
Review: Granular
cytoplasm, suggestive of hepatic
cells.

11. Xray Chest --- diaphragmatic
hernia
Antero
posterior Lateral

12. Cystic Mass 5cm in
Supraclavicular area ? node
Primary screener:
? Talc granules Too big , have another look

13. Have a look at High Power!
Rostellum of hooklets, scolices, suckers----
Echinococcus granulosis

14. Histology: no laminated membrane, but cross
section of rostellum

15. FNA of Parotid Gland male age 35
 Clear Fluid aspirated:
 Primary screener:
 “Contaminants, dust or
pollen.
 Review: Scolices
 ENT surgeons:
Disbelief !
 So “cut it out”

16. The specimen in the Bottle

17. Histological appearance

18. Laminated membrane, Echinococcus

19. What’s left in the bottle ?

20. Small monomorphic lymphocytes
and ? “fibres”

21. Larva with constriction in gut
 Literature search
revealed several
publications with similar
MRI findings.
 Eosinophilia not always a
feature
 Treat with Albendozole
and cortisone
 Patient got out of bed
four days later
 Repeat MRI

22. Clear CSF. ? Lymphoma
 Primary screener : few lymphocytes
 Review: Lymphocytes degenerative changes.
No polymorphs.
 No eosinophils
 ? Larval worm ? Toxocara
 I conveyed my findings to the clinicians, they
came rushing to the lab with copies of the
MRI.

23. Woman 45yr sudden onset transverse
myelitis. Lower body paralysis. Arms
paralysed. CSF clear fluid for cytology

25. ? Larva of Toxocara

26. Bony lesion: Female sheep farmer from
The Karoo, knee joint destroyed.
?Aneurysmal Bone Cyst.