There’s more to cytology than meets the eye final 3
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Transcript of There’s more to cytology than meets the eye final 3
There’s more to Cytology than meets the Eye
Genevieve Warner Learmonth
When screening a slide, note carefully what you observe, no matter how odd it may seem,
Before you make up your mind,OPEN IT!
There’s a bone in her mouth!
But isn’t a giraffe herbivorous?
Cervical smear, age 40Screening programme
Primary screener: “carbon laden macrophages”
Or is it melanin?
Patient referred for Colposcopy & Biopsy
Brown lesion on ectocervix Histopathology: malignant melanoma
FNA Breast: on - site breast clinic
Screener phoned me and described “smear is black. I think I can see carbon laden macrophages”.
The aspirate looks like liquorice !”
Slides referred via vacuum tube direct to Cytology Laboratory
Cytology comment was queried by senior colleagues ,so the mass was excised, Histological findings --- probable lymph node relpaced by diffuse fibrosis and anthracosis. No lypmhoid tissue remaining. No epithelial cells present.Conclusion: Hut Breast
Further Enquiry
The female patient was admitted to hospital for investigation of dyspnoea ? TB.
Chest Xray showed diffuse fibrosis ? Pneumoconiosis. The mass in the upper outer
quadrant of the breast was an incidental finding !!
Patient was sent to the breast Clinic
Hut dweller from Transkei, inhalation of smoke in huts, termed “hut Lung” Prof Bateman ( GSH 1992). Mediastinal lymphatics are overwhelmed with carbon. Intramammary nodes involved as well as neck nodes.
FNA Mass in Right lower lobe of Lung, female 32yrs old.
CytologyReview
Primary screener: “highly atypical cells”.
Plentiful cytoplasm
Round nuclei
?Bronchiolar alveolar carcinoma?
Correlate with Chest Xray in view of age.
Review: Granular cytoplasm, suggestive of hepatic cells.
Xray Chest --- diaphragmatic hernia
Antero posterior Lateral
Cystic Mass 5cm in Supraclavicular area ?
nodePrimary screener: ? Talc granules
Too big , have another look
Have a look at High Power! Rostellum of hooklets, scolices, suckers---- Echinococcus granulosis
Histology: no laminated membrane, but
cross section of rostellum
FNA of Parotid Gland male age 35
Clear Fluid aspirated:
Primary screener: “Contaminants,
dust or pollen. Review: Scolices ENT surgeons:
Disbelief ! So “cut it out”
The specimen in the Bottle
Histological appearance
Laminated membrane, Echinococcus
What’s left in the bottle ?
Small monomorphic lymphocytes and ? “fibres”
Larva with constriction in gut Literature search
revealed several publications with similar MRI findings.
Eosinophilia not always a feature
Treat with Albendozole and cortisone
Patient got out of bed four days later
Repeat MRI
Clear CSF. ? Lymphoma
Primary screener : few lymphocytes Review: Lymphocytes degenerative
changes. No polymorphs. No eosinophils ? Larval worm ? Toxocara I conveyed my findings to the
clinicians, they came rushing to the lab with copies of the MRI.
Woman 45yr sudden onset transverse myelitis. Lower body paralysis. Arms paralysed. CSF clear fluid for cytology
? Larva of Toxocara
Bony lesion: Female sheep farmer from The Karoo, knee joint destroyed. ?Aneurysmal Bone Cyst.
Dedicated to the late Dr Moira Durcan