Download KCP 790

KCP 790
연세대학교 의과대학 세브란스 병원
전공의 오은지
Patient history
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M/64
특이병력 없음
어지러움을 주소로 내원
영상 소견
– 뇌 MRI, 흉부 CT 상에서 다발성 뇌 경색 및 폐 색전증 소견 보였으
며, 경부 CT상 다발성의 좌측 level Ⅲ, Ⅳ, Ⅴ, 쇄골상 림프절 비대
가 관찰되었고, 복부 CT 상에서도 양측 서혜부, 외장골, 내장골, 총
장골, 대동맥 주위 림프절 비대 소견이 관찰되었습니다.
• 좌측 쇄골상 림프절에서 세침흡인
Cytologic findings
• Lymphoid background
• Cell clusters: papillary, solid, acinar, and microacinar
arrangement
• Single scattered cells
• Small uniform round cells
• Overlapping
• High N/C ratio
• Hyperchromatic
• Prominent nucleoli
• Delicate, fine and focal vacuolated cytoplasm
Differential diagnosis
• Lymphoma
• Metastatic carcinoma
– Well differentiated adenocarcinoma
• Biliary tract/stomach/colon/lung etc.
– Prostatic adenocarcinoma
– Breast lobular carcinoma
– Neuroendocrine tumor
• Lymphoma
– Monotonous, equal size의 lymphoid cell
– Cluster를 이루지 않고 single cell로 나옴
• Well differentiated adenocarcinoma
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(biliary tract/lung/stomach/colon etc.)
Many individual cells + 3-D clusters
Cohesiveness↓, polarity↓, nuclear enlargement, high N/C ratio,
prominent nucleoli, hyperchromasia, variable mucin
Biliary tract: Large 3-D cluster, coarse chromatin clumping
Lung: 3-D cluster (acini, tubule, papillae), fine granular to
powdery chromatin, round to oval nuclei, variable cell size
• Neuroendicrine tumor
1) Carcinoid
• Dispersed or small groups (forming flat, loosely structured gland
like clusters)
• Uniform appearance: cuboidal or rectangular with faintly
basophilic transparent cytoplasm and eccentric nuclei,
plasmacytoid nuclei, fine granular chromatin (“salt and pepper”),
tiny nucleoli, occasional giant cells
2) Well differentiated neuroendocrine carcinoma
(atypical carcinoid)
• Organoid arrangement, high mitotic rate, prominent nucleoli (single
or multiple) and focal necrosis
• variable nuclear size, hyperchromasia, abundant cytoplasm, nonpyknotic ovoid nuclei, clear cytoplasm
• Breast lobular carcinoma
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Small cell size, minimal atypia, intracytoplasmic vacuole
Indistinct nucleoli, intracytoplasmic neolumina (12-57%)
Dispersed cells, no acini
Extremely rare (1% of male breast cancer)
• Prostatic adenocarcinoma
– 비교적 uniform한 cell들의 small cluster or acini
– Small, round to oval cells
– Enlarged, round nuclei, increased N/C ratio, moderate amount of
cytoplasm
– Microacinar pattern과 prominent nucleoli가 가장 특징적인 소견
Differential diagnosis
• Lymphoma
• Metastatic carcinoma
– Well differentiated carcinoma
• Biliary tract/stomach/colon/lung etc.
– Prostatic adenocarcinoma
– Breast lobular carcinoma
– Neuroendocrine tumor
Diagnostic Cytopathology
2007
2011
• Small- to medium sized relatively uniform cells
• Small clusters forming acini, solid, and cirbriform microacinar +
scattered single cells
• Loss of honeycomb
• Moderately enlarged, hyperchromatic nuclei with mild nuclear
membrane irregularities
• Nuclear membrane irregularity, hyperchromasia와 chromatin clumping
은 다양하게 나타나지만 often minimal
• Prominent nucleoli (single or multiple)
• Delicate and finely vacuolated cytoplasm
• Neuroendocrine differentiation (10-33%)
• Immunohistochemical pannel
– PSA (prostate-specific antigen), PSAP (prostatic acid phosphatase), and AMACR (alphamethylacyl-CoA racemase)
Diagnosis
• Positive for malignancy, metastatic carcinoma,
see note.
Note)
1. The possibility of metastatic adenocarcinoma
from prostate can be suggested.
2. Further evaluation is recommended.
감사합니다.