Case Of The Month - May 2005

Specimen type:	Pleural Fluid
Clinical History:	71 yr old male Massive right-sided pleural effusion
Preparation:	The specimen was centrifuged at 1500 rpm for 10 minutes and cytospin paps and diff- quick slides were prepared. Material submitted for cell block, was subsequently processed by the histology department.
Images:	2x cytospin paps ( Image1, Image2) 2x diff- quicks ( Image3, Image4) 1x H&E stained cell block preparation ( Image 5)

Images

Image 1

Image 2

Image 3

Image 4

Image 5

Discussion

• The preparations were highly cellular and contained discohesive malignant cells.
• Mono and binucleation was a feature of the abnormal cells.
• The malignant cells were round to oval and displayed a degree of pleomorphism.
• Chromatin was coarsely granular and featured prominent nucleoli.
• Cytological features were highly suggestive of a carcinoma.

Immunostains

• BerEP4 positivity and LCA, Melan-A and Calretinin negativity, supports the diagnosis of an epithelial tumour
• TTF1[images 6 and 7 below]and cytokeratin 7 were positive while cytokeratin 20 high molecular weight keratin and PSA are negative

Image 6

Image 7

Diagnosis

The features are consistent with a carcinoma, with immunophenotyping suggesting a primary non-small cell lung carcinoma.

NOTE:
Pathologist telephonic enquiry with the consulting physician, indicated, that the patient had a hilar mass, thus confirming a lung tumour.

Thanks to Krish Pillay for submtting this case

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