Monthly Archives: March 2012

One simple trick to obtain paraffin embedded tissue from cytological specimen

Intro:

In some selected cases, in addiction to the diagnosis oncologists are asking cytopathologists to do immunohistochemistry they need to make decisions about patient. Gold standard is biopsy but this can’t be done in all of the cases.

Often the cytological specimen is too much bloody and the cells are dispersed in more than one slide, also considering the extracellular substances may inhibit immuno-reaction, we find very difficult to meet the demand.

This is the way to obtain material to obtain paraffin embedded tissue for further investigation/ancillary methods:

  • wash the syringe & the needle used to obtain material with saline solution
  • centrifuge (2000 rpm 2 min.)

  • discard excess fluid
  • sediment: add 10% formalin  & alcohol 95% solution (50%/50%) 
  • centrifuge (1500 rpm 2 min.)
  • transfer the sediment in the cassette

  • processing and inclusion in paraffin
  • ready to go

Example – Case Report: Peri-rectal lymphadenopathy

 Clinical History:

 Age: 71, Sex:  female

Patient previously trated with surgery and chemoterapy for right colon adenocarcinoma (2007) T3N1, M1

 Cytological specimen: EUS-FNA

PAP 200X

PAP400X

PAP200X

PAP400X

Preliminary cytological diagnosis : Positive for malignancy – adenocarcinoma

Paraffin embedded tissue from cytological specimen

H/E 20X

H/E 100X

H/E 200X

CDX2+

 CDX2+

final diagnosis: Metastasis from colonic adenocarcinoma (recurrence of disease)

Case Report N° 14 – Cytology & histology must go together

Click here for Case Report N°14

Cytology Quiz N°12 – Pancreatic mass EUS-FNA

Click here for the new cytology quiz

Case Report N°13 – small cell lung carcinoma

small cell lung carcinoma

Melanoma: cytological features

Malignant cells from Melanoma (epitheliod & pleomorphic subtype) usually contain moderate amounts of cytoplasm, and cytoplasmic melanin pigment is identified in tumor cells. Melanin pigment may also be seen in macrophages. The cells exhibit moderate to marked nuclear pleomorphism and, in some cases, contain binucleate and multinucleate cells. Nuclear chromatin is finely or coarsely granular, and nuclear membrane irregularities may be seen. Nucleoli are often prominent, and some cells may contain large eosinophilic macronucleoli. Intranuclear cytoplasmic invaginations (pseudoinclusions) may be seen.  Sometimes the background contains necrotic debris.

Short clinical history:

Ascites (cytology) &  Bone lesion (histology) in patient with primary cutaneus melanoma.

Cytological material:  Ascites

A-PAP 100X

A) The cells are often dispersed singly and occasionally in loose aggregates

B-PAP200X

B) In the middle of the field one large, pleomorphic epithelioid cells. Some cells containing granular cytoplasmic melanin pigment

C-PAP400X

C) Malignant cells with intranuclear cytoplasmic invaginations (pseudoinclusions)

D-PAP200X

D) Melanin pigment may also be seen in macrophages and in the background.

E-MGG200X

E) May Grunwald stain

Histological speciemen:

Bone metastases of the same case. Immunohystochemistry for this case is not available (it was performed on the primary tumor, in other istitution).   

F) Histology: ee 20x

F

G) Histology: ee 40x

G

H) Histology: ee 100x. 

H

Reference:

Cytologic features of metastatic and recurrent melanoma in patients with primary cutaneous desmoplastic melanoma Am J Clin Pathol 2008;130:715-723.

All of the images showed are from my private collection.

my IAC Certificate

20120306-214134.jpg

CASE REPORT N°12 – Nipple Discharge

click here for the Nipple Discharge case report