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.

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请Dr.cqzhao先喝杯茶，休息一下！

 赵老师好!如果在一楼加入新图片,如天山望月所说,点"编辑",继续上传.

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 More photos

Pap 400x

名称：图1
描述：图1

名称：图2
描述：图2

 恶性，考虑低分化腺癌，胞浆似有粘液样空泡，联系临床病史，原发或转移？

不排除恶性组织细胞增生症。

 Thank Dr. Chen's analysis. Pt has hx of ENT carcinoma. I asked the cytofellow to find surgical slides to review. My initial differeential dx includes sarcoma and carcinoma (especial RCC and squamous ca based on the hx even though the morphologic features do not look like). Some IHC stains I ordered on site have completed. I have not read them yet. I was in a shadysite cancer center for FNA last week and come back Magee this week. The fellow told me that epithelial markers are positive (PanCK, CK7), squamous markers and TTF1 are negative, vimentin and CD10 positive, EMA negative. I called the primary doctor and told him it is a carcinoma. I ordered more IHC and will review the initial stains tomorrow. Now my differential diagnoses are metastatic RCC (no any history) and metastatic poorly differential nasopharygeal ca. How do I know it is not a lung primary tumor? I will reveiw the original ENT tumor and think more how to signout the case finely.

I will like you know when I have more information.

To pathologists in China:

You see FNA cytology is interesting.

  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。