Non Gynea-His (Cyto) .PPTX 2

NON- GYNEA
1) Respiratory tract
2) Urine
3) Pleural, pericardial, and peritoneal fluids
4) Peritoneal washings
5) Cerebrospinal fluid
6) Gastrointestinal tract
7) Breast
8) Thyroid
9) Salivary gland
10) Lymph nodes
11) Liver
12) Pancreas
13) Kidney and adrenal gland
14) Ovary
15) Soft tissue
1) RESPIRATORY TRACT
 NORMAL
 BENIGN
 MALIGNANT
NORMAL
Cytomorphology :
Title: Ciliated columnar cell

Upper respiratory tract Source:
http://www.czytelniamedyczna.pl/img/ryciny/newmed/2
 Ciliated columnar cells 007/04/images/20070411.jpg
 Squamous cells
Lower respiratory tract

• Trachea and bronchi
 Ciliated columnar cells
 Goblet cells
 Title: Goblet cell

Basal/reserve cells
Source:
http://www.siumed.edu/~dking2/erg/images/GI125a1.jpg
 Neuroendocrine cells
• Terminal bronchioles
 Non ciliated cuboidal/columnar cells (Clara cells)
 Alveoli Type I and II pneumocytes

 Alveolar macrophages
BENIGN
Cytomorphology
Pulmonary hematoma
 Bland spindle cells
 Immature fibromyxoid matrix
 Mature cartilage with chondrocytes in lacunae
 Benign glandular cells
 Adipocytes
Inflammatory myofibroblastic tumor
 Spindle cells
 Title: cytomorphology of benign cell in respiratory tract
Storiform pattern
Source:http://www.pathologyoutlines.com/caseofweek/case200710
 Polymorphous inflammatory cells 0pap.jpg
 Minimal to no necrosis
Endobronchial granular cell tumor
 Small clusters of macrohage-like cells
 Abundant granular cytoplasm
 Small, uniform, round to oval nuclei
MALIGNANT
Cytomorphology :
Squamous cell carcinoma
 Abundant dyshesive cells
Title : Squamous Cell Carcinoma
 Polygonal, rounded, or elongated cells Source : http://nih.techriver.net/patientImages/5713.jpg
 Dense cytoplasmic orangeophilia (Papanicolou stain)
 Tadpole or fiber - like cells
 Pleomorphic, pyknotic nuclei
 Obscured nucleoli and chromatin detail
 Frequent anucleated cells
 Twisted keratin strands (Herxheimer spirals)
Title: Immunocytochemical positive staining for carcinoembryonic antigen

Adenocarcinoma (CEA) on the metastatic pulmonary adenocarcinoma in pleural fluid.
 Cohesive sheets – 3D clusters, acini Source :
http://www.acta-cytol.com/feature/2007/feature022007.php
 Accentric, irregular nuclei
 Finely to coarsely granular chromatin
 Large nucleoli
 Secretory vacuoles
 Transparent, foamy cytoplasm
2) URINE
 NORMAL
UROTHELIAL CELLS
 INFLAMMATION
 REACTIVE
 UROTHELIAL NEOPLASM
LOW GRADE UROTHELIAL LESIONS
HIGH GRADE UROTHELIAL CARCINOMA
 OTHER MALIGNANT LESIONS

SQUAMOUS CELL CARCINOMA
NORMAL
UROTHELIAL CELLS
 Scanty cellularity in voided sample

 Cells are usually single in voided urine
 Clusters or sheets of urothelial cells in cystoscopy urine and bladder washings
 Umbrella cells, deeper layer cells, squamous cells seen
 A few polymorphs may be seen
 Spermatozoa and corpora amylacea may be present in males
Umbrella cells . These are the largest urothelial cells and cover the surface of the
urothelium. Normal columnar urothelial
cells are also pesent
(Diagnostic principles and clinical correlates cytology,

2nd edition, Edmund and Barbara)
INFLAMMATION
 Hazy or turbid urine specimen

 Numerous polymorphs, histiocytes, occasionally eosinophil
 Reactive changes in epithelial cells
 Organisms may be present, bacteria or parasitic
 Evidence of associated pathology may be seen such as debris in the presence of calculi
Polyomavirus infection. The enlarged nucleus is

virtually replaced by a glassy, homogeneous
inclusion.

REACTIVE
N/C ratio: mild increase

 Cytoplasm: retain cytoplasmic clearing
 Nuclear borders : - normal
 Chromatic: finely granular
 Nucleoli: prominent in all cells
 Mitosis: few (if any) and normal
Reactive urothelial cells (catheterized urine).

Coarsely vacuolated cytoplasm is characteristic of
benign, reactive changes and uncommon in malignancy
UROTHELIAL NEOPLASM
LOW GRADE UROTHELIAL LESIONS
 Cytoplasmic homogeneity
 High nuclear to cytoplamic ratio
 Irregular borders
 Papillary fragments with fibrovascular cores(diagnostic, but rare)
 Cell clusters without cores
 Irregular cell clusters ( commonly associated with UC than smooth cell clusters)
cytologic criteria for the diagnosis of a low grade urothelial lesion

(catheterized specimen). Homogeneous cytoplasm, an increased
nuclear to cytoplasmic ratio, and irregular nuclear outline are
associated with low-grade lesions, but are not specific.
HIGH GRADE UROTHELIAL CARCINOMA
 High nuclear to cytoplasmic ratio

 Marked nuclear hyperchromasia
 Coarsely granular chromatin
 Irregular nuclear outline
 Large nucleoli (some cases)
High-grade urothelial lcarcinoma. Numerous

isolated malignant cells have enlarged, dark nuclei and an
increased nuclear to cytoplasmic ratio.
OTHER MALIGNANT LESIONS
SQUAMOUS CELL CARCINOMA
 Cytoplasmic keratinization
 Pearls
 Bridges
 Angulated hyperchromatic nuclei
Urothelial carcinoma
3) PLEURAL, PERICARDIAL AND
PERITONEAL FLUIDS
(EFFUSIONS)
 BENIGN
 MALIGNANT
BENIGN
Benign effusions contain mesothelial cells, histiocytes and lymphocytes.
Cytomorphology
Mesothelial cells
 Numerous, isolated cells, small cluster with ‘windows’, single nucleolus, dense cytoplasm with clear
outer rim (lacy skirt), round cells and nucleus.
Histiocytes
 Smaller nuclei than mesothelial cells, folded nuclei, cytoplasm granular/vacuolated, no ‘windows’
between adjacent cells.
MALIGNANT
Tips for detection: Second population, numerous large clusters and lacunae (cell block sections).
Cytomorphology
Malignant mesothelioma
~Common pattern
Large cluster with scalloped (knobby) edges, cytomegaly, prominent nucleoli, bi/multinucleation, dense
cytoplasm with peripheral halo, windows, normal nc ratio, round and center nuclei.
~Uncommon pattern
Predominant isolated tumor cells, lymphocytes only, tumor cells with abundant lymphocytes and
histiocytes, psammoma bodies and cytoplasmic vacuolation.
4) PERITONEAL WASHING
 NORMAL
 MALIGNANT
NORMAL
- Mesothelial cells in sheets and clusters.

- Collagen balls 5%
- Histiocytes muscle.
- Adipose tissue
MALIGNANT
 Isolated cells and clusters.

 Large cells. Peritoneal wash: Suspicious for pancreatic carcinoma.60x .
 Cells in cluster.
Marked variation in nuclear size.
http://www.cytologystuff.com/indexnongyn.htm?
 Nuclear hyperchromasia. section9ng.htm
 Prominent nucleoli.
 Mitoses.
 Vacuolated cytoplasm (some cells)
Peritoneal wash: Suspicious for pancreatic carcinoma .

Cells in cluster with larger cells and variation in nuclear size.
Vacuoalation cytoplasm seen.
http://www.cytologystuff.com/indexnongyn.htm?
section9ng.htm
5) CEREBROSPINAL FLUID
 NORMAL
 BENIGN
 MALIGNANT
NORMAL
Common
• Lymphocytes
• Monocytes
Rare
• Choroid plexus /ependymal cells
• Brain fragment
• Germinal matrix
• Chondrocytes
• Bone marrows
Title : Normal cell in CSF . Dark purple stain is lymphocyte.
Source: http://serc.carleton.edu/images/woburn/all_csf_150.jpg
BENIGN
Abnormal inflammatory cells

 Plasma cells
 Macrophage
 Neutrophils
Non neoplastic disorder

 Numerous neutrophils
 Bacteria
 Viruses Title: Cytomorphology of fungal (cryptococcus sp.) infection in cerebrospinal
 Fungi fluid.
Source:http://sociedaddecitologia.org.ar/sac/images/stories/galerias/criptoc
ocosis/dsc00371.jpg
MALIGNANT
Cytomorphology :
Adenocarcinoma
 Large cells
 Isolated or small cluster
 Abundant cytoplasm
 Accentric nucleus
Title: Diff Quick staining of the cerebrospinal fluid reveals adenocarcinoma

Small cell carcinoma Source:http://img.medscape.com/fullsize/migrated/507/124/mgm507124.fi
 Small cells g2.gif
 Isolated or small cluster

 Abundant cytoplasm
 Accentric nucleus
6) GASTROINTESTINAL TRACT
 ESOPHAGUS
Barrett’s esophagus , Dysplasia in Barrett’s esophagus
Low-grade dysplasia, High-grade dysplasia
Adenocarcinoma
Uncommon tumors
 STOMACH
Adenocarcinoma
 DUODENUM
Adenoma and Adenocarcinoma
ESOPHAGUS
Barrett’s esophagus
Cytomorphology:
 Epithelial repair
 Goblet cells
Differential diagnosis
 Intestinal metaplasia of the gastric cardia
Dysplasia in Barrett’s esophagus Barrett’s epithelium with goblet cells. A single large cytoplasmic
vacuole expands the apical portion of the cytoplasm and displaces
Cytomorphology the nucleus and shapes it into a crescent against the basal cell
membrane
 Background of Barrett’s epithelium
Scattered atypical cells with some but not all

features of adenocarcinoma
Low-grade dysplasia
Cytomorphology:
 Crowded groups with stratification
 Mild nuclear atypia and pleomorphism
Low-grade dysplasia in Barrett’s epithelium. A fragment of

glandular epithelium with stratified elongated nuclei is seen.
High-grade dysplasia Although mucin depletion and slight nuclear enlargement are
seen, significant nuclear atypia is absent.
Cytomorphology
 Crowded groups or isolated cells
 Higher degree of nuclear atypia and

pleomorphism
High –grade dysplasia in Barrett’s epithelium. A sheet of irregular

Differential diagnosis arranged cell with variable enlarged nuclei is present without
evident dyshesion. In spite of the increase nuclear to cytoplasmic
 Regenerative epithelium ratio, nuclear membrane irregularities, and slight hyperchromasia,
the atypia is insufficient for a definitive diagnosis of malignancy.
 adenocarcinoma
Adenocarcinoma
Cytomorphology:
 Increased cellularity
 Abnormal cellular arrangement

 Atypical nuclear features
 Various amount of vacuolated cytoplasm

 Tumor diathesis
 Barrett’s epithelium may or may not be present
in the background
Adenocarcinoma. The nuclei show significant

hyperchromasia with chromatin clumping and
Differential diagnosis clearing and large prominent nucleoli.
 Epithelial repair
 Dysplasia in Barrett’s epithelium, particularly
high grade
 Poorly differentiated squamous cell carcinoma
Cytomorphology – well differentiated squamous cell

carcinoma:
 Hyperchromatic / pyknotic nuclei
 Completely obscured chromatin
 Variable cell shapes (round, oval or spindled)
 Irregular, angulated nuclei
 Keratinized cytoplasm (‘hard’ or ‘glassy’ orangeophilia)
 Sharp cytoplasmic border
 Prominent necrosis/ tumor diathesis
Well-differentiated squamous cell carcinoma. Two spindled-shaped

Cytomorphology – poorly differentiated squamous cell keratinized malignant-squamous cells with orangeophilic cytoplasm
carcinomas and hyperchromatic nuclei show markedly abnormal chromatin
distribution. Degenerated cells with pyknotic nuclei are in the
 Less keratinization, nuclear angularity, and pyknosis background.
 Indistinct cell borders
 Coarsely textured chromatin
 Prominent nucleoli
Uncommon tumors
Cytomorphology – uncommon tumors:
 Verrucous carcinoma
 Minimal cytologic atypia
 Adenosquamous carcinoma
 Both malignant squamous and glandular elements
 Mucoepidermoid carcinoma
 Mucinous, squamous, and intermediate cell s in varying
proportions
 Basaloid carcinoma Helicobacter pylori (gastric brushings).
Numerous faintly basophilic S-shaped
 Tight and loose groups of crowded dark basaloid cells
rods are entrapped in mucus.
 Often misdiagnosed as an adenoid cystic carcinoma
 Adenoid cystic carcinoma
 Cribriform, pseudoacinar, and small duct-like structures
 Small cell carcinoma
 Small or intermediate-sized cells
 Scant cytoplasm
 Prominent molding
 Necrosis and nuclear streaking common
STOMACH
Adenocarcinoma
Cytomorphology – signet ring cells
Small groups or isolated cells
Vacoulated cytoplasm, often a single large vacuole
Crescent-shaped, angulated, hyperchromatic nuclei
Signet ring cell carcinoma (gastric brushings). A group of malignant

signet ring cells is seen. They have characteristic large vacuoles that
shape the nucleus into a crescent against the cell membrane. In
contrast to benign goblet cells, the nuclei in malignant signet ring
cells are hyperchromatic and angulated
DUODENUM
Adenoma and Adenocarcinoma
Cytomorphology:
 Cohesive three-dimensional clusters of

crowded epithelial cells
 Increased nuclear to cytoplasmic ratio
 Absent goblet cells
 Palisading and molding of elongated nuclei Ampullary adenoma (ampullary brushings). A crowded group of glandular
cells with mucin depletion and an increased nuclear to cytoplasmic ratio
is present. A gland opening is apparent. In spite of the crowding, the
 Fine chromatin and absent or small nucleoli arrangement is orderly. The nuclei are enlarged and elongated but
significant atypia is present.
7) BREAST
 BENIGN
 MALIGNANT
BENIGN
Cytomorphology
~Fibroadenoma
 Hypercellular
 Large honeycomb sheets, 3D clusters with antler-like configuration, bipolar cells and spindled/oval naked
nuclei, fibrillar stromal fragments (bluish gray with Papanicolaou stain/intensely red-purple with
Romanowsky type stain), nuclear atypia, some loss of epithelial cohesion, regular nuclear spacing, finely
granular chromatin pattern, small and round nuclei.
MALIGNANT
Cytomorphology
- Breast cancer
Tubular carcinoma
Hypercellular smear due to dense of fibrosis, predominantly cohesive, often angular

clusters(comma-shaped or cornucopia-shaped), some dyshesion, uniform, medium- sized tumor
cells with round, uniform nuclei, fine granule chromatin, small nucleoli and occasionally cells have
large cytoplasmic vacuole.
-Uncommon breast tumor
Aporine carcinoma
Hypercellular specimen, cluster, sheets and isolated cells, abundant granular

cytoplasm with indistinct cell borders, enlarged nuclei with irregular contours, prominent large
nucleoli and necrotic debris.
8) THYROID
 BENIGN
 MALIGNANT
Papillary carcinoma
Anaplastic carcinoma
Medullary carcinoma
Lymphoma
BENIGN CONDITIONS
Subacute granulomatous (De Quervain’s) thyrioditis

Hashimoto’s thyroiditis. Lymphoid cells are the
Cytomorphology: predominant feature. Most are small, mature
lymphocytes.
 Granulomas
 Giant cells
 Lymphocytes
Chronic lymphocytic (Hashimoto’s) thyroiditis
Cytomorphology: Hashimoto’s thyroiditis. Hurthle cell with

abundant cytoplasm are usually identified in
 Mixed population of lymphocytes clusters.
 Tingible-body macrophages
 Lymphohistiocytic aggregates
MALIGNANT TUMORS
Papillary carcinoma
Cytomorphology:
 Sheets, papillae, or microfollicles
 Nuclear changes
Suspicious for a Hurthle cell neoplasm. These enlarged
 ‘powdery’ chromatin cells with abundant granular cytoplasm were interpreted
as suspicious, but the patient proved to have a
 Grooves multnodular goiter with extensive clear cell change.
 Pseudoinclusions
 Nucleoli (small or large)
 Membrane irregularity
 Nuclear crowding/molding
 Variable cytoplasm (scant, squamoid, Hurthle-like,

or vacuolated)
Papillary carcinoma. In some cases, papillae are absent,
and the neoplastic cells are arranged in crowded sheets.
 Psammoma bodies Psammoma bodies are present.
 Histiocytes, including multinucleated giant cells

Anaplastic carcinoma
Cytomorphology:
 Mostly single cells
 Marked nuclear pleomorphism
 Large cells
 Epithelioid or spindle shaped
 Squamous differentiation (some cases)

Anaplastic carcinoma. Tumor cells are dispersed
as isolated cells. Nuclei are large,
 Giant cells
hyperchromatic, and irregular shaped.
 Tumor type
Osteoclast type
Medullary carcinoma
Cytomorphology:
 Numerous single cells
 Loose clusters
 Epithelioid, plasmacytoid, and/or spindle-shaped cells
 Nuclei Medullary carcinoma. Smears show numerous

isolated cells and small blobs of amyloid. (arrows)
 Round or elongated
 Finely or coarsely granular chromatin
 Inconspicious nucleoli
 Pseudoinclusion (50% of cases)
 multinucleated
 Red cytoplasmic granules (70% of cases)
 amyloid Medullary carcinoma. Air-dried Romanowsky-

stained preparation show fine red cytoplasmic
granules, a helpful diagnostic features.
Lymphoma
Cytomorphology – MZL type:
 Small lymphoid cells
 Centrocytes
 Plasma cells
 Monocytoid B cells
 Interspersed large lymphoid cells
Cytomorphology – DLBL type: Marginal zone B-cell lymphoma of MALT type. The
neoplastic lymphoid cells are uniformly small, with
 Large lymphoid cells irregularly shaped nuclei a moderate amount of
cytoplasm.
 Centroblast
 Immunoblasts
 Burkitt-like cells
9) SALIVARY GLAND
 NORMAL
 BENIGN
 MALIGNANT
CARCINOMA & ADENOCARCINOMA
SMALL CELL CARCINOMA
NORMAL
 Serous and mucinous-type acinar cells

 Small sheets and tubules of ductal epithelium
 Adipose tissue
Title: Major of salivary gland cell

Source: http://flylib.com/books/2/953/1/html/2/21%20-%20Serous
%20Membranes_files/DA6C21FF4.png
BENIGN
 Epithelial cells
 Myoepithelial cells
 Chondromyxoid matrix
Title: Aspiration from benign salivary gland

Source:http://www.nature.com/modpathol/journal/v15/n3/thumbs/388052
8f4th.jpg
MALIGNANT
CARCINOMA & ADENOCARCINOMA
Cytomorphology:
Carcinoma
 Mucus cells ( predominate in low grade tumors)
 Intermediate cells
 Mucinous background
 Overt cytology malignancy (high grade tumors)
Adenocarcinoma
 Cellular aspirate of biphasic cells in 3D cluster
 Large clear myoepithelial cells with moderate to abundant cytoplasm and vesicular nuclei
 Small dark ductal cells with scant cytoplasm
 Peripheral homogenous acellular basement membrane material
 Background naked nuclei
Title: Interpretation of suspicious adenoid cystic carcinoma
Source: http://www.pathologyimagesinc.com/sgt-cytopath/chronic-inflamm-
sialadenitis/cytopathology/diff-diagn/fs-chr-sialad-dd.html
Title: Metastatic squamous cell carcinoma

Source:http://pathology2.jhu.edu/cytopath/masterclass/images/salivary/1sa
lp3a.jpg
MALIGNANT
SMALL CELL CARCINOMA
Small cell carcinoma
Extranodal marginal zone B-cell lymphoma of MALT type

 Small to intermediate size lymphocytes
 Round to slightly irregular nuclei
 Occasional immunoblasts
 CD 45+, CD20+, CD23-, CD10-,CD5-, cyclin D1-
Folicular lymphoma
 Mixed population of small and large cleaved and large non-cleaved cells
 CD45+, CD20,CD10+,CD5-
Diffuse large B-cell lymphoma

 Large markedly atypical lymphocytes
 CD45+,CD20+, keratin-, S-100-
10) LYMPH NODES
 NON – NEOPLASTIC LESIONS

 NEOPLASMS
NON – NEOPLASTIC LESIONS
Cytomorphology
- Reactive hyperplasia
~ Polymorphous population, small lymphocytes, centrocytes, centroblast, immunoblast, tingible
– body macrophages, lymphohistiocytic aggregates, capillaries, eosinophils and mast cells.
-Inflammatory/infectious condition
~Sarcoidosis
- Granulomas, epithelioid histiocytes, multinucleated giant cells, lymphocytes and clean

background.
NEOPLASMS
Cytomorphology
Hodgkin Lymphoma
Small lymphocytes, eosinophils (especially in mixed cellularity subtype), Reed – Sternberg cells, classic and
mononuclear variants, no lymphohistiocytic aggregates/tingible – body macrophages (exceptions: partial node
involvement and lymphocyte predominant Hodgkin lymphoma)
Non-Hodgkin Lymphoma (small lymphocytic lymphoma)

Monomorphous small lymphocytes clumped chromatin, smooth/minimally irregular nuclear contour, small
nucleoli, scant cytoplasm, prolymphocytes and paraimmunoblasts, no tingible – body macrophages or
lymphohistiocytic aggregates.
11) LIVER FNAC
 NORMAL
 MALIGNANT
NORMAL
Hepatocytes
 Large polygonal cells.
 Isolated cells, thin ribbons (trabeculae), or larger tissue fragments.
 Centrally placed, round to oval and variably sized nuclei.
 Commonly binucleated
 Intranuclear pseudoinclusions.
 Abundant granular cytoplasm.
Pigment:
a)Lipofuscin (common:a normal pigment related to cellular aging-golden with the Papanicolaou strain and
green-brown with a Romanosky-type strain.
b)Homosiderin: (less common : when present in large quantities it suggests a disoder of iron matabolism)-dark
brown with the Papanicolaou strain and blue with with a Ramonowsky-type strain.
c)Bile( not visible under normal conditions but seen in cholestasis) -dark green with both Papanicolaou and
Romanosky strain.
MALIGNANT
MALIGNANT:
 Highly cellular smears with single cells or cords, nests, tubules, or sheets.
 Spindle-shaped endothelial cells surround thickened cords of neoplastic hepatocytes.
 Neoplastic hepatocytes have an increased nuclear to cytoplasmic ratio
 Granular cytoplasm with bile or hyaline globules( red with Papanicolaou and blue with Romanosky
stains)
 Large, round nuclei with prominent nucleoli
 Intranuclear pseudoinclusions.
 Large naked nuclei.
Malignant: liver FNAC
Liver FNA, Hepatocellular Carcinoma. Liver FNA, Hepatocellular Carcinoma.

Poorly differentiated hepatocellular carcinoma in which the hepatocytes Loose cluster of malignant hepatocytes from an aspirate of
show marked nuclear enlargement with nuclear irregularity and very hepatocellular carcinoma. There is uniform atypicality with
prominent nucleoli. increased nuclear-to-cytoplasmic ratios. Some bile pigment is
60x noted between the hepatocytes. 40x
http://www.cytologystuff.com/indexnongyn.htm
Liver FNA - Cirrhosis

Individually scattered benign binucleated hepatocytes
from a cirrhotic nodule. 40x
12) PANCREAS
 BENIGN
PANCREATIC ACINAR EPITHELIUM
PANCREATIC DUCTAL EPITHELIUM
 REACTIVE
 NEOPLASM
DUCTAL ADENOCARCINOMA
ACINAR CELL CARCINOMA
BENIGN
PANCREATIC ACINAR EPITHELIUM
 acinar arrangement or isolated cells

 eccentrically placed, round nucleus
 evenly distributed, finely granular chromatin
 inconspicuous nucleolus
 abundant granular cytoplasm
 indistinct cell borders
Normal pancreatic acinar cells (Papanicolaou stain)

PANCREATIC DUCTAL EPITHELIUM
A
 Flat, cohesive epithelial sheets (few single cells)
 Round to oval nuclei
 Evenly distributed, finely granular chromatin
 Even nuclear spacing
 Well defined cytoplasmic boundaries
 No nuclear crowding or overlapping
Pancreatic ductal epithelial cells. (a) Forming a

honeycomb sheet. (b) Palisading groups with
basally located nuclei

REACTIVE
REACTIVE DUCTAL ATYPIA
 Low cellularity
 Flat, cohesive sheets
 Uniformly spaced nuclei
 Round to oval nuclear contours
 Rare intact single atypical cells
Marked reactive atypia of ductal epithelium in the setting

of chronic pancreatitis. (a)Note the nuclear enlargement
and overlapping, and prominent nucleoli.
(b) The nuclear are basally located, however, with
smooth, round contours and evenly distributed chromatin.

NEOPLASMS
DUCTAL ADENOCARCINOMA

2nd edition, Edmund and Barbara) a
 Increased cellularity
 Cohesive epithelial sheets ( with rounded edges)
 Nuclear crowding and overlapping
 Increased intracytoplasmic mucin
 Focally irregular nuclear contours (pyramidal and carrot-shaped nuclei)
b
 Nuclear enlargement (particularly marked anisonucleosis within a single
sheet)
 Irregular chromatin clearin g
Pancreatic ductal adenocarcinoma

(a) Compare the appearance of this disordered, crowded
Sheet with the normal ductal epithelium. (b) Irregular nuclear
c
Contours and marked nuclear enlargement are evident.
(c) Irregular chromatin distribution and hyperchromasia.
ACINAR CELL CARCINOMA
 Groups of cells in nest, cords, or acini

 Increased single cells
 Nuclear irregularity, crowding, overlapping
 Increased nuclear to cytoplasmic ratio
 Conspicuous nucleoli
 Absence of ductal epithelium
Acinar cell carcinoma

(http://en.wikipedia.org/wiki/File:Acinic_cell_carcinoma.jpg)
13) KIDNEY AND ADRENAL
GLAND (FNA)
 KIDNEY AND ADRENAL GLAND

NORMAL
MALIGNANT
 KIDNEY
NORMAL
Glomeruli, Proximal tubular cell & Distal tubular cell
Oncocytoma
MALIGNAT
Clear cell type
chromophobe type
 ADRENAL GLAND
NORMAL
MALIGNANT
Adrenal cortical carcinoma
Pheochromocytoma and Metastatic carcinoma
NORMAL: KIDNEY AND ADRENAL GLAND
Glomeruli:
 Cytomorphology:
Differential diagnosis:
 Large papillary structures.  Oncocytoma
 Capillary loops.  Chromophobe RCC
 Differential diagnosis:
Distal tubular cells:
 Papillary RCC ( renal cell carcinoma) Cytomorphology:
 Rare cells with scant cytoplasm and minimal
Proximal tubular cells: atypia.
 Cytomorphology: Differential diagnosis
 Low grade clear cell or papillary RCC
 Rare cells with abundant granular cytoplasm.
MALIGNANT: KIDNEY AND ADRENAL
GLAND (FNA)
MALIGNANT:
Clear cell/ conventional renal cell carcinoma

Cytomorphologic:
Large cohessive groups.
Abundant clear and granular cytoplasm.
Large, round, eccentrically placed nucleus with prominent nucleolus.
Differential diagnosis:
Large cohessive groups
Abundant clear and granular cytoplasm.
Large, around, eccentrically placed nucleus with prominent nucleolus
NORMAL: KIDNEY
FNAC
Oncocytoma:
 Clean Background
 Dyshesive Single Cells or Loose Clusters, No Stripped Nuclei
 Rarely in Large Groups (Unlike RCC)
 Small Uniform Nuclei, Smooth Borders (Unlike RCC)
 Focal Nuclear Atypia, Binucleation, Inconspicuous Nucleoli
 Abundant Uniformly Granular Well-defined Cytoplasm
 No Vacuoles (Unlike RCC)
 Sharp Well Defined Cell Border (Unlike PCT Cells)
 Hale's Colloidal Iron Negative, or Perinuclear/atypical Staining Present
 Electron Microscopy: Mitochondria
 MIMICS: PCT, Chromophobe RCC, Conventional RCC with Granular Cytoplasm
Renal Cell Carcinoma
Kidney - oncocytoma
60x
MALIGNANT: KIDNEY (FNA)
 Conventional/common/clear cell type (CRCC):


 Clean or necrotic background
 Cohesive monolayered sheets (unlike oncocytoma)
 Prominent branching capillaries
rare single cells (low grade) ® more single cells and stripped nuclei (higher grades) (unlike oncocytoma)
 Bland nuclei, no nucleoli (low grade)
 Larger atypical nuclei, some bizarre, nucleoli prominent (higher grade), (unlike oncocytoma, chromophobe RCC).
 Eccentric nucleus, extruded from cells
 More uniform nuclei than chromophobe rcc
 Foamy vacuolated cytoplasm (unlike onc and normal)
 Clear, or granular (not uniform) abundant cytoplasm (low N/C ratio)
 Intracytoplasmic mallory-like bodies
 Vimentin, cytokeratin positive (use biotin block)
 Hale's colloidal iron negative
 Electron microscopy: glycogen, lipid; mitochondria in some
 MIMICS: distal convoluted tubule and collecting duct, oncocytoma, chromophobe RCC
Chromophobe Type:
 Clean background
 Sheets, clusters, single cells (dyshesive, but less than CRCC)
 Bare nuclei (unlike oncocytoma)
 More variation in cell & nuclear size (than oncocytoma, CRCC)
 Vesicular nuclei, binucleation, inclusions
 Irregular nuclear outline (unlike oncocytoma, CRCC)
 Prominent nucleoli in some abundant granular cytoplasm
 Perinuclear clearing, prominent cell borders ("koilocytic")
 Fluffy/clear/granular not uniform cytoplasm
 Vimentin negative, cytokeratin positive (use biotin block)
 Hale's colloidal iron positive - uniform, dense, cytoplasmic
 Electron microscopy: microvesicles; mitochondria if eosinophilic variant
 MIMICS: oncocytoma, CRCC
Malignant: Kidney (FNA)
Kidney - renal cell carcinoma

Conventional type. Monolayered sheets of foamy Kidney - renal cell carcinoma
vacuolated cells with low N/C ratios, eccentric nuclei, Conventional type. Cluster of foamy vacuolated
minimal nuclear atypia and small nucleoli. Nuclei appear cells with eosinophilic intracytoplasmic Mallory-
uniform. 40x like bodies. 60x
NORMAL: ADRENAL
GLAND (FNA)
Abundant foamy granular lipid rich background appears Adrenal gland - normal cortex Clusters of vacuolated
in clumps on thin layer. Entrapped vacuolated cells with cells with bland round smoothly contoured nuclei,
round bland regular nuclei. Note bare stripped nuclei as small nucleoli and fragile frayed cytoplasmic edges.
well. 40x 60x
MALIGNANT: ADRENAL GLAND (FNA)
MALIGNANT:
Adrenal cortical carcinoma

• MIMICS Adenoma Features
• Necrosis May be Present
• May See Malignant Nuclear Criteria
• Histological Assessment Required to Distinguish Larger Adenomas from
Carcinomas
• Similar Immunoprofile as Adenoma
• MIMICS: May be Indistinguishable from Normal Adrenal Gland and
Adrenal Cortical Adenoma; Pheochromocytoma, Other Malignancies, if Poorly Differentiated
Adrenal gland, Metastatic adenocarcinoma

Prominent 3-D cell ball formation without intercellular Adrenal gland, Metastatic adenocarcinoma
windows indicating glandular differentiation. 60x
60x
Adrenal gland, Metastatic small cell carcinoma Adrenal gland, Metastatic small cell
60x carcinoma
60x
14) OVARY
BENIGN
Serous cystadenoma and cystadenofibroma, Mucinous cystadenoma
MALIGNANT
~Papillary serous cystadenoma of low malignant potential and serous
cystadenocarcinoma
~Mucinous cystadenoma of low malingnant potential and cystadenocarcinoma
~Endometrioid carcinoma
BENIGN EPITHELIAL NEOPLASMS
Serous cystadenoma and cystadenofibroma
Cytomorphology:
 Cuboidal cells
 Ciliated cells
 Detached ciliary tufts
 Psammoma bodies (rare) Serous cystadenoma. Benign ciliated cells have

basally placed nuclei, terminal bars, and cilia.
Mucinous cystadenoma
Cytomorphology:
 Mucinous cells
 Isolated cells, ribbons, sheets
 Macrophages Mucinous cystadenoma. Among the macrophages are

fragments of benign mucinous epithelium
 Extracellular mucin endocervial epithelium.
MALIGNANT EPITHELIAL NEOPLASMS
Papillary serous cystadenoma of low malignant
potential and serous cystadenocarcinoma
Cytomorphology: serous tumor of low malignant potential

Serous of low malignant potential tumor. The cells are arranged
 Twisted sheets and spheres in a crowded sheet. There is mild to meoderate atypia.
 Branching clusters
 Mild to moderate nuclear atypia
 Large cytoplasmic vacuoles (some cells)
 Psammoma bodies
 Stripped fibrovascular cores In this tight spherical aggregate, some cells have
large cytoplasmic vacuoles
Cytomorphology: serous cystadenocarcinoma

 Cluster and isolated cells
 Large pleomorphic cells
 Round nuclei Psammoma bodies are a common finding
 Psammoma bodies
Mucinous cystadenoma of low malingnant potential
and cystadenocarcinoma
Cytomorphology: Mucinous cystadenoma

 Columnar mucinous cells with mild atypia and/or
groups of pleomorphic large cells with prominent
nucleoli Papillary serous cystadenocarcinoma. The malignant
cell often have large, round and pleomorphic nuclei,
 Cytoplasmic vacuolization and nucleoli and prominent
 Macrophages
Other cells are markedly atypical Mucinous cystadenocarcinoma. Some sheets of

and difficult to recognize as mucinous cells show only mild atypia
mucinous origin
Endometrioid carcinoma
Cytomorphology:
 Numerous isolated cells
 Strips and/or crowded glands
 Palisading
 Elongated columnar shape
 Clear cell carcinoma
Endometrioid adenocarcinoma. The cells have elongated nuclei and a

narrow columnar shape. Some are arranged in pseudostratified strips
and glands.
15) SOFT TISSUE
 SPINDLE CELL NEOPLASMS

LEIOMYOSARCOMA
SCHWANNOMA
 ROUND CELL NEOPLASM

DESMOPLASTIC SMALL ROUND CELL TUMOR
ALVEOLAR RHABDOMYOSARCOMA
CONTENTS
SPINDLE CELL NEOPLASMS
LEIOMYOSARCOMA
 Naked nuclei
 Loose clusters
 Spindle-shaped cells
 ‘cigar-shaped’ nuclei
 Abundant homogeneous cytoplasm
 mitoses
Leiomyosarcoma. Nuclei are hyperchromatic with finely or slightly coarsely

granular chromatin in lower-grade lesions and more coarsely clumped chromatin in
the high-grade lesions.
SCHWANNOMA
 Large, cohesive fragments

 Wavy, ‘fishlook’ nuclei
 Pointed nuclear ends
 Nuclear palisading
 Filamentous cytoplasm
Schwannoma. The cells of benign schwannoma grow in a

syncytial fashion with indistinct cell borders

ROUND CELL NEOPLASM
DESMOPLASTIC SMALL ROUND CELL TUMOR
 Sheets and clusters of cells

 Fragments of variably cellular stroma
 Uniformly round to oval cells
 Nuclear molding
Desmoplastic small round cell tumor.

This differs from other round cell lesions in
That its undifferentiated neoplastic cells
retain a loose cohesiveness and are rarely
Singly dispersed.

ROUND CELL NEOPLASM
ALVEOLAR RHABDOMYOSARCOMA
 Larger, uniformly round to polygonal cells

 Predominantly undifferentiated cells ( early rhabdomyoblasts)
 Multinucleated giant tumor cells
Alveolar rhabdomyosarcoma. The cells disperse

individually, but are generally larger and more
uniformly round to polygonal than those seen in
embryonal rhabdomyosarcoma .


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NON- GYNEA

Title: Ciliated columnar cell

Lower respiratory tract

 Title: Goblet cell

 Non ciliated cuboidal/columnar cells (Clara cells)

 Alveoli Type I and II pneumocytes

Title: Immunocytochemical positive staining for carcinoembryonic antigen

 OTHER MALIGNANT LESIONS

 Scanty cellularity in voided sample

(Diagnostic principles and clinical correlates cytology,

 Hazy or turbid urine specimen

Polyomavirus infection. The enlarged nucleus is

(Diagnostic principles and clinical correlates cytology,

N/C ratio: mild increase

Reactive urothelial cells (catheterized urine).

LOW GRADE UROTHELIAL LESIONS

cytologic criteria for the diagnosis of a low grade urothelial lesion

 High nuclear to cytoplasmic ratio

High-grade urothelial lcarcinoma. Numerous

SQUAMOUS CELL CARCINOMA

Benign effusions contain mesothelial cells, histiocytes and lymphocytes.

- Mesothelial cells in sheets and clusters.

 Isolated cells and clusters.

Peritoneal wash: Suspicious for pancreatic carcinoma .

Abnormal inflammatory cells

Non neoplastic disorder

Title: Diff Quick staining of the cerebrospinal fluid reveals adenocarcinoma

 Isolated or small cluster

Scattered atypical cells with some but not all

 Crowded groups with stratification

 Mild nuclear atypia and pleomorphism

Low-grade dysplasia in Barrett’s epithelium. A fragment of

 Crowded groups or isolated cells

 Higher degree of nuclear atypia and

High –grade dysplasia in Barrett’s epithelium. A sheet of irregular

 Abnormal cellular arrangement

 Various amount of vacuolated cytoplasm

Adenocarcinoma. The nuclei show significant

Cytomorphology – well differentiated squamous cell

 Completely obscured chromatin

 Variable cell shapes (round, oval or spindled)

 Irregular, angulated nuclei

 Keratinized cytoplasm (‘hard’ or ‘glassy’ orangeophilia)

 Sharp cytoplasmic border

 Prominent necrosis/ tumor diathesis

Well-differentiated squamous cell carcinoma. Two spindled-shaped

 Indistinct cell borders

 Coarsely textured chromatin

Cytomorphology – signet ring cells

Small groups or isolated cells

Vacoulated cytoplasm, often a single large vacuole

Crescent-shaped, angulated, hyperchromatic nuclei

Signet ring cell carcinoma (gastric brushings). A group of malignant

Adenoma and Adenocarcinoma

 Cohesive three-dimensional clusters of

 Increased nuclear to cytoplasmic ratio

 Absent goblet cells

Hypercellular smear due to dense of fibrosis, predominantly cohesive, often angular

-Uncommon breast tumor

Hypercellular specimen, cluster, sheets and isolated cells, abundant granular

Subacute granulomatous (De Quervain’s) thyrioditis

Chronic lymphocytic (Hashimoto’s) thyroiditis

Cytomorphology: Hashimoto’s thyroiditis. Hurthle cell with