I see pathologists in China are not very interested in FNA. Send a cses for discussion.

Older women with a liver mass with a history of intestinal tumor 20 y ago.

FNA of liver mass with DQ and Pap stains

（abin译：我发现国内病理医生对FNA不太感兴趣。上传一例供讨论。病史：老年女性，肝肿块，20年前有肠肿瘤病史。肝肿块FNA标本DQ染色和巴氏染色）

 谢谢赵老师！如此漂亮的图片！

成簇片状的小圆细胞，可见腺样和菊形团样，小圆细胞核略偏位，核膜厚，染色质粗糙，隐约可见核仁。

结合肠肿瘤病史，考虑神经内分泌癌（类癌）转移。需排除其他小细胞肿瘤。

All three got correct dx or interpretation.

1. cell block

2. CD56, somatostatin, glucagon, insulin stains

3.Synaptophysin

4. chromogranin

Previous slides are not available for review. The cytologic features, IHC and history are consistent with metastatic carcinoid.

Few people are interested in FNA cytology or this case is too easy. In fact FNA cytology is the most interesting area. I will show some differential dx.

（abin译：楼上三位的诊断或解释都是对的。

1.细胞块

2.CD56、生长抑素、胰高血糖素和胰岛素染色

3.突触素

4.嗜铬素

无法获得以前的切片供复阅。细胞学特征、IHC和病史均符合转移性类癌。

很少人对FNA细胞学感兴趣或者这一例太简单了？实际上FNA细胞学是最有趣的领域。以后我会提供一些鉴别诊断。）

Differential diagnosis鉴别诊断:

 Colon adenocarcinoma结肠腺癌

 Malignant lymphoma恶性淋巴瘤

 Small cell carcinoma小细胞癌

 Malignant Melanoma恶性黑色素瘤

 Breast carcinoma乳腺癌

 Gastric carcinoma胃癌

 Squamous cell carcinoma鳞状细胞癌

 Benign hepatocytes and bile duct epithelium良性肝细胞和胆管上皮细胞

  （天山望月译）

F 1-2 normal liver cells  图1-2为正常肝细胞

3. normal liver bile ductal cell  图3正常肝内胆管细胞

4. metastatic gastric ca  图4转移性胃癌

5. metastatic colonic ca  图5转移性结肠癌

6. lymphoma  图6淋巴瘤

7-8 samll cell carcinoma  图7-8小细胞癌

9-10 melanoma  图9-10恶黑

11. squamous cell ca  图11 鳞癌

（abin译）

Differential Diagnoses-Liver Metastases; (Carcinoid tumor)

鉴别诊断--类癌肝转移

nColon adenocarcinoma: Necrosis, columnar, hyperchromatic nuclei

结肠腺癌：坏死，柱状，核深染

nLymphoma: Discohesive, atypical large lymphocytes, apoptotic bodies

淋巴瘤：粘附性差，非典型性大淋巴细胞，凋亡小体

nSmall cell Carcinoma: pleomorphism, single files, nuclear molding

小细胞癌：多形性，单行排列，核镶嵌（铸型）

nMalignant melanoma: Discohesive, melanin pigment, binucleation, grooves, intranuclear pseudoinclusions

恶黑：粘附性差，黑色素，双核，核沟，核内假包涵体

nGastric carcinoma: Signet ring cells

胃癌：印戒细胞

nBreast carcinoma: Signet ring cells

乳腺癌：印戒细胞

（abin译）

Cytology- Carcinoid Tumor

n       Loosely cohesive groups & single  monomorphic cells

n       Rosettes

n      Round or plasmacytoid cells

n      Round to oval  nuclei

n      Finely granular “salt and pepper” chromatin

n      Stripped nuclei

n      Basophilic  cytoplasm

Intestinal Carcinoid tumor

n      Low grade malignancy arising from intraepithelial endocrine stem cells in crypts.

n      Most common in the ileum, also  distal duodenum .

n      Can metastasize to regional lymph nodes, liver, bone, skin & thyroid.

n      Carcinoid syndrome: 20% with metastases, ↑ Serotonin production:

n      palpitations

n      cutaneous flushes

n      intestinal hypermotility: vomiting &diarrhea

n      Bronchospasm

n      HTN

n      Right valvular heart disease

Intestinal Carcinoid tumor

n      Clinically diagnosis :

n       plasma levels of glycoprotein chromogranin A .

n        24 hour  urine levels of  5-hydroxyindoleacetic acid (5-HIAA ), a breakdown product of serotonin.

n      IHC: positive for Synaptophysin, Chromogranin, CD56 +/- (most specific marker is chromogranin)

n      5 year survival: 35% with metastases, 70% localized.

 Ok, hope more people like FNA cytology.

cqz

 FNA diagnosis is a weakness of chinease pathologists. 

 Thank you for such a useful introduction and expecting for more later!

同感！本人对细胞学非常感兴趣！

 谢谢Dr.cqzhao！有幸分享如此漂亮的图片！

5楼免疫组化结果也支持转移性类癌。

 谢谢Dr.cqzhao！

7楼的图片非常清晰漂亮！又各有不同的特点，比较典型。

 The cytologic features, IHC and history are consistent with metastatic carcinoma

Sorry. Should be metastatic carcinoid

（abin译：细胞学特征、免疫组化和病史均符合转移性类癌）