KCP 783 이대목동병원 박희정

건강검진상 시행한 흉부 컴퓨터 단층 촬영(CT)에서 결절이 발견 55세 남자 건강검진상 시행한 흉부 컴퓨터 단층 촬영(CT)에서 결절이 발견 기관지 내시경상에서 혈관이 풍부한 기관지내 종괴가 관찰되었습니다. 기관지 내시경 검사 중 종괴에서 세침흡인을 시행하였고 보내드린 슬라이드는 세침흡인 세포 도말입니다.

흉부 컴퓨터 단층 촬영(CT)에서 우중엽의 기관지 내강을 채우는 조영증강이 잘되는 약 3cm 크기의 종괴가 관찰되었고 주변에 조영증강이 잘 되는 크기가 커진 림프절들도 관찰되었습니다

기관지 내시경상에서 혈관이 풍부한 기관지내 종괴가 관찰되었습니다 기관지 내시경상에서 혈관이 풍부한 기관지내 종괴가 관찰되었습니다. 기관지 내시경 검사 중 종괴에서 세침흡인을 시행하였고 보내드린 슬라이드는 세침흡인 세포 도말입니다.

error 세침흡인검사 (fine needle aspiration/EBUS) 기관지 세척액 (bronchial washing cytology)

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Cytologic features No pleomorphism, mitosis, necrosis Numerous dispersed individual cells forming infrequently small groups and clusters Fibrovascular connective tissue (delicate branched capillary blood vessel) Tumor cells surrounding, and clinging to, the arborising delicate capillaries Bland, uniform, monotonous small cells with minimal or no variation in cell size Eccentric round nuclei with fine granular chromatin Inconpicuous nucleoli Scanty to moderate basophilic cytoplasm No pleomorphism, mitosis, necrosis

Differential diagnosis Malignant lymphoma Small cell carcinoma Carcinoid tumor Large cell neuroendocrine carcinoma Adenocarcinoma

Differential diagnosis Malignant lymphoma - no intercellular cohesion - nuclear membrane irregularity - nucleoli+ Small cell carcinoma Carcinoid tumor Large cell neuroendocrine carcinoma Adenocarcinoma

Differential diagnosis Small cell carcinoma - more irregular nuclear contour - pyknosis, necrotic debris - nuclear molding - necrotic background - hyperchromasia - many naked nuclei and nuclear streaking Carcinoid tumor Large cell neuroendocrine carcinoma Adenocarcinoma

Differential diagnosis Large cell neuroendocrine carcinoma - nuclear peomorphism - cohesive cells - fine chromatin - prominent nucleoli - increased mitotic rate - necrotic background Adenocarcinoma Carcinoid tumor

Differential diagnosis Adenocarcinoma -more cytologic atypia -mucin production Carcinoid tumor Small cell carcinoma Malignant lymphoma Large cell neuroendocrine carcinoma

Mucicarmine stain

Ttf-1 cd56

TTF-1 CD56 Ttf-1 cd56

TTF-1 CD56 Chromogranin Synaptophysin Ttf-1 cd56

Cytologic diagnosis Carcinoid tumor

Ki-67

Atypical carcinoid tumor Final diagnosis Atypical carcinoid tumor

Pathologic criteria of neuroendocrine neoplasm of lung Typical carcinoid Atypical carcinoid Small-cell lung cancer Large-cell neuroendocrine carcinoma Light microscopic morphology Neuroendocrine morphology (organoid nesting, palisading, rosettes, trabeculae) Neuroendocrine morphology Small size (less than the diameter of 3 small lymphocytes) 1.Scant cytoplasm 2. finely granular chromatin, absent nuclei or faint nucleoli 1.Neuroendocrine morphology 2. Cytologic features of non-small cell carcinoma: large cell size, vesicular, coarse or fine chromatin and/or nucleoli 3.Positive IHC stain for one or more NE markers or neuroendocrine granules by EM, Mitoses per 2mm2 <2 2-10 and/or foci of necrosis >10 Necrosis no Often punctate Frequent, large zone Often large zones Histologic grade Low Intermediated High

Cytologic diagnosis and differential diagnosis of lung carcinoid tumors a retrospective study of 63 Cases with histologic correlation. Cancer Cytopathol. 2010 Dec 25;118(6):457-67. 63 cases: cytology with corresponding surgical material cytology specimens : 49 -FNA specimens 14 -brushings/washings. Discordant cases (31 cases,49%) - Overdiagnosis as small cell carcinoma (4 cases; 6%) adenoid cystic tumor (4 cases; 6%) poorly differentiated carcinoma with NE features (5 cases; 8%) - Misdiagnosis of other lesions as TC (4 cases; 6%)

Cytologic diagnosis and differential diagnosis of lung carcinoid tumors a retrospective study of 63 Cases with histologic correlation. The significant morphologic factors : nuclear features, chromatin patterns, nucleoli. Nuclear molding and crowding: not discernible features Crush artifact : low and high grade Ki-67 staining: useful

Variety of histologic patterns and tumor cells trabecular, palisading, rosette-like, spindle, glandular, papillary oncocytic, melanin-rich, mucin-producing, signet ring , clear, acinic-like, pleomorphic, bizarre Stromal component: psammomatous, ossification, amyloid deposition

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