January 20, 2009

28 y/o female. Thin Prep. A. Atypical glandular cells (AGUS)B. HSILC. Tubal metaplasiaD. Benign endometrial cellsE. Adenocarcinoma1

28 y/o female. Thin Prep. A. Atypical glandular cells (AGUS)B. HSILC. Tubal metaplasiaD. Benign endometrial cellsE. Adenocarcinoma1

The cells are hyperchromatic and overlapping; however cilia is present. Tubal metaplasia of endocervical cells can often be confused for HSIL/AGUS, but cilia denotes a benign process.

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33 y/o female. Thin Prep Pap. Based on the cells shown above, what is the appropriate management for the patient?

A. Repeat cytology in 6 monthsB. HPV molecular testingC. Repeat cytology in 1 year D. ColposcopyE. Observation

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33 y/o female. Thin Prep Pap. Based on the cells shown above, what is the appropriate management for the patient?

A. Repeat cytology in 6 monthsB. HPV molecular testingC. Repeat cytology in 1 year D. ColposcopyE. Observation

All high grade lesions (HSIL) go straight to colposcopy.

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18 y/o female. Thin Prep Pap. Based on the cells shown, what isthe appropriate management for the patient? A. Repeat cytology in 6 monthsB. HPV molecular testingC. Repeat cytology in 1 year D. ColposcopyE. Observation

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18 y/o female. Thin Prep Pap. Based on the cells shown, what isthe appropriate management for the patient? A. Repeat cytology in 6 monthsB. HPV molecular testingC. Repeat cytology in 1 year D. ColposcopyE. Observation

For adolescents (20 years and younger), the new guidelines recommend repeat cytology at 12 months for both ASCUS and LSIL

45 y/o female. FNA of thyroid.A. Reactive, neg for malignancyB. GoiterC. Indeterminate for malignancy.D. Papillary carcinoma.E. Hashimoto’s thyroiditis

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45 y/o female. FNA of thyroid.A. Reactive, neg for malignancyB. GoiterC. Indeterminate for malignancy.D. Papillary carcinoma.E. Hashimoto’s thyroiditis

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Oncocytes

Cluster of lymphocytes and dispersed lymphs in the background

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54 y/o female. Thin Prep pap. A. HSILB. AdenocarcinomaC. Benign endocervical cellsD. Benign endometrial cellsE. Squamous cell carcinoma

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54 y/o female. Thin Prep pap. A. HSILB. AdenocarcinomaC. Benign endocervical cellsD. Benign endometrial cellsE. Squamous cell carcinoma

Glandular cells with large pleomorphic nuclei and prominent nucleoli. Can appreciate some overlapping/architectural disorder.

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23 y/o female. Thin Prep pap. A. ASCUSB. Squamous metaplasiaC. HSILD. Endocervical cellsE. LSIL

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23 y/o female. Thin Prep pap. A. ASCUSB. Squamous metaplasiaC. HSILD. Endocervical cellsE. LSIL

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FNA of salivary gland mass. PAP stain

A. Pleomorphic adenomaB. Mucoepidermoid carcinomaC. Normal salivary glandD. Adenoid cystic carciomaE. Myoepithelioma

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FNA of salivary gland mass. PAP stain

A. Pleomorphic adenomaB. Mucoepidermoid carcinomaC. Normal salivary glandD. Adenoid cystic carciomaE. Myoepithelioma

Myoepithelial cells embedded in stroma

Chondromyxoid stroma is present here. In this case, it is lacking the typical “fibrillary” appearance.

55 yo female. Breast mass. FNAA. Benign ductal cells B. FibroadenomaC. Apocrine metaplasiaD. Breast carcinomaE. Phyllodes tumor 8

55 yo female. Breast mass. FNAA. Benign ductal cells B. FibroadenomaC. Apocrine metaplasiaD. Breast carcinomaE. Phyllodes tumor 8

Disorderly sheets of crowded cells. Cells are pleomorphic, nuclear enlargement, coarse chromatin and prominent nucleoli.

75 yo female with idiopathic fibrosis. BAL

A. Candida B. Aspergillus speciesC. PneumocystisD. CMVE. Amoeba

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75 yo female with idiopathic fibrosis. BAL

A. Candida B. Aspergillus speciesC. PneumocystisD. CMVE. Amoeba

Just to prove you can see fungus on Pap stain. If only the boards were this easy…

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44 yo female with liver lesion. FNA

A. Positive – c/w hepatocellular carcinoma

B. Positive – c/w melanoma metC. Positive – c/w colon cancer metD. Benign liver cellsE. Benign bile duct cells

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44 yo female with liver lesion. FNA

A. Positive – c/w hepatocellular carcinoma

B. Positive – c/w melanoma metC. Positive – c/w colon cancer metD. Benign liver cellsE. Benign bile duct cells

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