| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- Lung mass FNA today Please join in the discussion
图1
图2
图3
图4
图5
图6
Old man with a lung mass 3 cm.
Radiologist did CT-guided FNA and I did on site evaluation this afternoon. I called malignant cells based on above one DQ. The procedure was stopped because patient had bleeding and also I think I should have enough cells for a cell block. Cytopathologists are required to give diagnosis (at least malignant, atypical, benign) on site in our institute if it is possible.
In fact I really do not know what kinds of tumor for this case. I have not seen the Pap stain yet. I have my differential dx and ordered some IHC already.
Hope people who see this case write down your differential dx and IHC.
When I have IHC results I will put here.
标签：
×参考诊断
低分化非小细胞癌
-
本帖最后由 于 2008-12-09 23:18:00 编辑
（续）
列出的所有免疫组化结果（如上述）。
结合细胞形态和免疫结果是低分化非小细胞癌。免疫组化结果与颈部肿块（病例号）相似，这可能提示二者相似或为同一肿瘤。无法获得以前的切片供复习。鉴别诊断包括但不局限于肺的低分化腺癌或鼻咽癌转移，上消化道来源包括食道、胃、胰腺。CA9、vimentin和CD10阳性，提示可能为转移性肾细胞癌。建议临床作有关的影像学检查。
我和Dr. xxxx (责任医生) at 3:30 PM, on m/d/y.讨论了此病例。
Dr. xxxxx (细胞病理学家) 和Dr. xxx (泌尿生殖病理学家)也看了此例，并同意上述解释。
以上是我对此病例做出的诊断。
- 广州金域病理
-
本帖最后由 于 2008-12-09 23:10:00 编辑
大致翻译26楼，不当之处请Dr.cqzhao指正！谢谢！
这个主题已经发表2个星期，我希望我中国同行能够加入讨论。事实上，主要是我和陈博士在这里讨论。如果我俩之间要讨论病例，是不需要放在这里来的。如果你认为自己的细胞病理学知识比较薄弱并且想学习，你需要更积极地参与讨论。
不管怎样，现在我总结一下。
我签发的报告如下：
最后诊断：
CT引导细针穿刺活检，左肺肿块。
标本质量满意。
阳性，发现恶性细胞。
低分化非小细胞癌（见评论） 。
评论：
穿刺吸取物涂片示细胞丰富，在血性的背景上呈现单一的、粘附性差的恶性细胞团。肿瘤细胞体积大，明显多形性，有丰富的空泡状到浓染胞浆，核深染，形状不规则，有突出的核仁。细胞块示相似的细胞学特征。为了进一步明确肿瘤细胞性质，用细胞块作免疫标记，如果如下。
- 广州金域病理
Thank Dr. Chen, 天山望月's discussion and 月新老师的翻译.
I put this topic here for 2 weeks already. I hope my colleagures in China can join the discussion. In fact it seems that I and dr chen are main persons in discussion here. We do not need to put cases here if we want to discuss some cases. You need to be more active if you think you are weak and want to learn cytopathology.
Anyway I summarize the case now.
i sign out the case as following:
FINAL DIAGNOSIS:
Lung Mass, left, CT-Guided Fine Needle Aspiration Biopsy"
SATISFACTORY FOR INTERPRETATION.
POSITIVE FOR MALIGNANT CELLS.
POORLY DIFFERENTIATED NON-SAMLL CELL CARCINOMA (SEE COMMENT).
COMMENT:
The aspiration smears are cellular and reveal single and dyschhesive clusters of malignant cells in a blood background. The tumor cells are large in size, very pleomorphic, and have abundant, vacuolated to dense cytoplasm, and hyperpchromatic nuclei with irregular contours and prominent nucleoli. Cell block contains similar cells with smears. To further cahracterize the tumor cells, immunohistochemical studies were performed on the cell block sections with the following results.
Lists of all the IHC results (I have mentioned above)
Combined the cytomorphologic and immunophenotypic findings are of a poorly differentiated non-small cell carcinoma. The immunoprofile of this lesion is similar to the neck mass (case No) and this may represent similar or same tumor. No slides of previous case are available for review. The differential diagnosis includes but is not limited to poorly differentiated adenocarcinoma of lung or metastatic carcinoma from nasopharyngeal origin, upper gastrointestinal origin including esophagus, stomach, pancreatobillary sites. In review of CA9, vimentin, and CD10 immunostain positivity in the present cells, it raises the possibility of metastatic renal cell carcinoma. Clincal correlation with imaging is recommedded.
I discussed the case with Dr. xxxx (primary physician) at 3:30 PM, on m/d/y.
Dr. xxxxx (cytopathologist) and Dr. xxx (GU pathologist) have reviewed the case and concur with above interpretation.
Above is present in my full final report.
Share some thought with you guys:
Previous surgical specimen is a neck mass diagnosed as poorly differentiated carcinoma. The origin of the neck mass was not known. I do not think the review of these slide can help me and this why I did not ask for these slides. This is complicated case and I cannot figure out the origin on FNA. It is fine that people know the limitation of the FNA cytology and even surgical pathology. In fact I will choose metastatic RCC if this is test, but not a true case.
Support RCC:
1.Multiple locations of metastasis
2.Cytologic features (even though the cytology of most RCC cases is not so ugly).
3. IHC results: positive for CD10, vimentin, CA9. CK7 is positive for papillary RCC. CK7 is negative in most conventional RCC cases, but some conventional cases can be positive. We cannot rule out RCC based on the positive CK7.
I feel unconfortable about RCC
The clinician said no lesion in kindey in imagining result.
I do not understand what carcinomas can be EMA purely negative.
Anyway this is what I can do for this case.
Suggest to you:
1. Know the limitation of cytopath and pathology.
2. Do not need to make a definite dx if you are not sure. Leave some spce for you.
3. Contact with the primary doctors to know the clinical information, let him know your interpretation. Record the comunication in your final report for some difficult case.
4. Show your case with other pathologists for some difficult cases and record in your report.
Thank for reading and discusing the case.
I would sign out this case using generic term, such as Non-small cell type carcinoma and then put a comment saying reviewing the patient's previous head&neck slides will be helpful, also ask the clinician to correlate clinically.
In our hospital (Cleveland Clinic), the oncologists are very understanding the limitations of pathology, if the lung has multiple nodules and they highly suspect metastasis, they will get the previous slides to you and do a "whole body" CAT scan. If there is only a single mass and the body scan is negative, they may just treat this as a primary lung Ca.
Thanks for sharing this case!
-
本帖最后由 于 2008-12-03 23:33:00 编辑
谢谢Dr.cqzhao！非常经典的病例！
新传21楼的图片，有腺样排列，有粘液样胞浆。
试着分析IHC:
HMB45, Melan A, S-100阴性，排除恶黑，
LCA阴性排除淋巴造血疾病？！
TTF1排除甲状腺癌转移.
CA9,CD10,PanCK,vimentin阳性，考虑肾透明细胞癌转移！？RCC 阴性？
与肺原发的透明细胞癌怎样鉴别？
CD7阳性，不知怎么解释？是否需排除胸腺癌？
呵呵，我的问题较多，请专家赐教！谢谢！
- 广州金域病理
Other IHC:
Negative: TTF1, CK20, EMA, RCC, S-100, HMB45, Melan A, LCA
Previous neck mass is a consult case and no slides available for review. Imaging study indicated no kidney lesions. Interesting to know how you sign out this case. Hope more people in China to join.
-
本帖最后由 于 2008-12-02 18:19:00 编辑
| 以下是引用cqzhao在2008-12-2 12:24:00的发言：
|
回Dr.cqzhao：如果想把更多的相片放1楼，请点编辑，继续上传就好了。
如果在回帖中放相片，先打几个字发表，然后点编辑再上传就好。
如果还不行，可能是网络问题，我发信息给坛主或管理员，请他们解决。
请Dr.cqzhao先喝杯茶，休息一下！
- 广州金域病理
| 以下是引用陈隆文博士在2008-11-26 6:42:00的发言： CK7 positivity and EMA negative would against renal clear cell carcinoma. This is either a primary lung large cell carcinoma or a metastasis from ENT. Reviewing the slides of the patient's previous ENT tumor is the key. Thanks Dr. Zhao for the update. |
试着意译，不当之处请陈博士修改，谢谢！
CK7阳性和EMA阴性针对肾透明细胞癌。这是肺大细胞癌或转移的ENT的任何一个。回顾分析病人的ENT肿瘤是关键。谢谢赵博士的更新。
- 广州金域病理
-
CK7 positivity and EMA negative would against renal clear cell carcinoma. This is either a primary lung large cell carcinoma or a metastasis from ENT. Reviewing the slides of the patient's previous ENT tumor is the key. Thanks Dr. Zhao for the update.
陈隆文博士译文： This case is interesting and may have a broad differential diagnosis. 本例非常有意思有许多需要鉴别，The monotonous population of cells is supporting a neoplastic process. 细胞形态比较单一，考虑为肿瘤，Cells are arranged loosely with little cohesion, cells have abundant cytoplasm with cytoplasmic vaculoes. 细胞结构松散，几乎没有一点排列，胞浆丰富，富含空泡I am wondering about the possibility of metastatic Renal Cell Carcinoma? 我有点怀疑是转移性肾细胞癌，Also adrenal cortical carcinoma is in the consideration.也考虑肾上腺皮质癌， If a young patient, germ cell tumor is in the mix? 如果患者年轻，生殖细胞肿瘤也不能完全放弃。What's the history?请详细告知病史， If I have the cell block, 如果有细胞块，I would do some keratin stains, S-100, LCA as my initial work-up. 我先要做CK，S-100，LCA。I look forward to hearing from Dr. Zhao. 我盼望着zhao大夫的最后结果。
