세포병리 슬라이드 집담회 (KCP-775 서울성모병원 ) 제출자 발표 서울성모병원 병리과 전공의 이영섭
History 63 세 남자 환자. 과거력 40 갑년의 흡연력 내원 3 개월 전 기침, 가래, 보행시 호흡곤란이 발생함. 흉부 전산화단층촬영에서 우폐 중엽에 다수의 종괴가 관찰되며, 우폐에 소량의 흉수가 관찰됨. 진단을 위해 흉수천자를 시행함.
Cytologic Findings A few clusters of small cells, which are about twice the size of lymphocytes, occasionally larger Evenly dispersed, powdery chromatin Nuclear molding Small to indistinct nucleoli Relatively scant cytoplasm
Differential Diagnosis Small cell carcinoma of lung Non-small cell carcinoma of lung Malignant mesothelioma Lymphoma
CD56a CK-7 TTF-1
Diagnosis Pleural fluid, aspiration; Malignancy. Small cell carcinoma.
Cytopathologic Challenges of Small Cell Carcinoma in Pleural Fluid Uncommon The overlapping morphology between non-neoplastic (lymphocytes) and similar neoplastic entities Scant cellularity Predominance of apoptosis or cellular debris Artifactual distortion
Cytomorphologic Spectrum of Effusion with SCC
1. Small-cell clusters with nuclear molding (41%)
2. Large-cell clusters mimicking non- small-cell carcinoma (34%)
3. Single-cell pattern mimicking non- Hodgkin's lymphoma (23%)
4. Other Features Nuclear molding (60%) Apoptosis (33%) Cannibalism (16%) Prominent nucleoli (20%) IHC Synaptophysin (82%) Chromogranin (24%)
Differential Diagnosis Large-cell clusters Adenocarcinoma Thymic well-differentiated neuroendocrine carcinoma Single-cell pattern Non-Hodgkin's lymphoma Embryonal rhabdomyosarcoma Merkel cell carcinoma Metastatic SCC of the uterine cervix
Conclusion Cytologic features suggesting small cell carcinoma Small clustering of atypical cells Nuclear molding Finely dispersed chromatin Scant of cytoplasm Frequent apoptotic bodies and cannibalism