Cytologically Yours: CoW: 20131216
Clinical Summary
The patient is an 66 year old white male with a history of smoking, COPD, and diabetes. The patient presented with increased shortness of breath.
Past Medical History
- Diabetes
- COPD
- Squamous cell carcinoma of skin
Past Surgical History
- Excision of squamous cell carcinoma
- Removal of adenomatous polyp of sigmoid colon
Clinical Plan
The differential diagnosis includes worsening of COPD. CT imaging of chest is performed.
Radiology
- CT Chest shows hilar lung mass and multiple mediastinal lymph nodes showing increased uptake on PET scan.
Pathology
Cytology
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4x magnification of a 4R lymph node. Groups of cohesive epithelial appearing cells can be seen on low power. Lymphoid tissue is not easily identified. -
20x magnification of a 4R lymph node. This is a cellular specimen with groups of cells along what appear to be a papillary or papillary-like structure. Single cells are also dispersed in the background. The cells are haphazardly arranged. -
40x magnification of a 4R lymph node. On higher power, the nuclei appear mildly atypical and the cytoplasm is delicate and finely vacuolated. The nuclear contours are somewhat irregular. -
Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical. -
Cell block of 4R lymph node. The cytoplasm does not appear as vacuolated on alcohol fixed cell block material, but the nuclei are relatively uniform, but somewhat atypical.
Immunohistochemistry
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CD56 on pleural fluid shows positive cytoplasmic staining. -
Synaptophysin on pleural fluid shows positive cytoplasmic staining.
Resident Questions
Final Diagnosis
Cytology
- Rapid diagnosis: Non-small cell carcinoma.
- Final diagnosis: Renal cell carcinoma.
Case Discussion
This is a classic case of metastatic renal cell carcinoma.
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