ANSWER TO KCIAPM CYTOLOGY SLIDE SEMINAR JULY 2014

1. Case12
53Y/F presented with dyspnoea – one
week. CxR – Pleural effusion +.
Pleural fluid cytology

4. 1. Adenocarcinoma – Metastatic Deposit
2. Metastatic Duct Carcinoma – Breast
3. Malignant Mesothelioma, Adenoca Deposit
4. Negative for Malignancy – Chylous Effusion
5. Adenocarcinoma
6. ?Mesothelioma
Case 12

5. Clinical Findings: Breathlessness,
cough with expectoration - 1week
H’gram – N, Biochem. – N
Pleural Fluid ADA – 1.1 (N-<10)
CT Thorax (27/6/12) –
Large left side Pl. effusion+
with collapse of Lt. Lower lobe,
partial collapse of Rt. Lower lobe.

6. Repeat CT scan - chest & Abdomen at KMIO:
(19/7/12)
Abdomen – NAD, including no lesion
in the ovaries
Chest: Loculated pleural effusion left
base with left pleural thickening
& minimal pericardial effusion

9. CK20CK7

10. TTF1

11. Repeat CxR immediately after
pleural fluid drainage – Irregular
spiculated ill-defined opacity in the
left prehilar region
Treated with targeted therapy –
Tab. Gefitinib 250mg/day
Responded well to therapy, last FU
23/8/13

12. DIAGNOSIS

13. Pleural Fluid – Positive for Malignancy,
Adenocarcinoma, of lung origin

14. Points to remember in fluid cytology
Negative cytology does not rule out
Malignancy
Importance - fluid Cell block

15. Additional/Ancillary studies - FNA
Cell blocks
Histochemistry
Immunohistochemistry
Electron microscopy
Flow cytometry
Immuno electron microscopy
Cytogenetic
Molecular pathology -In situ hybridization, PCR

16. What we have learnt from this?
FNA - A simple, cost effective, tolerable,
out-Patient procedure for rapid diagnosis of
both palpable/ nonpalpable lesions
A good imaging interpretation with correlation
of clinical history is mandatory for accurate
diagnosis of FNA material

17. FNA provides a good cytomorphology and
an additional cell block preparation helps in
ancillary studies on par with tissue biopsy
study for definitive diagnosis of the lesion

18. all
staff