CYTOLOGY MOCK EXAM, 1-31 CASES

Non-Gynae Cytology Dr D. N. Rana Consultant Cytopathologist/Clinical Lead in Non-Gynaecological Cytology Manchester Cytology Centre

NG-Set A 1 • 37 year old male • Lump right axilla ?Cause • FNA right axilla - 1 x direct spread (MGG) and 1 x SurePath (Pap)

NG-Set A 1 • Metastatic malignant melanoma • Positive for HMB45, S100, Melan-A and SOX10 • BRAF (Codon 600) mutation testing

NG-Set A 2 • 38 year old female • Right thyroid nodule and palpable left neck node • FNA left neck lymph node - 1 x direct spread (MGG) and 1 x SurePath (Pap)

NG-Set A 2 • Granulomatous lymphadenitis • Special stains (Grocott, PAS and AFB) • Microbiological analysis/TB bacteriology

NG-Set A 3 • 72 year old male • Pleural effusion ?Cause • Pleural fluid - 1 x cytospin (MGG) and 1 x SurePath (Pap)

NG-Set A 3 • Metastatic lung adenocarcinoma • Positive for BerEP4/MOC-31, CK7, TTF-1 and Napsin A; Negative for Calretinin/D2-40 and CK20 • EGFR/ALK/ROS1/PD-L1

NG-Set A 4 • 62 year old male • Right lower lobe lung mass • EBUS FNA station 4L - 1 x direct spread (MGG) and 1 x SurePath (Pap)

NG-Set A 4 • Metastatic squamous cell carcinoma • PD-L1

NG-Set A 5 • 51 year old male • Left thyroid nodule • FNA left thyroid - 1 x direct spread (MGG) and 1 x SurePath (Pap)

NG-Set A 5 • Papillary thyroid carcinoma (Thy5) • The RCPath system for reporting thyroid cytopathology

NG-Set A 6 • 62 year old female • Smoker. Lump left supraclavicular fossa ?Cause • FNA left supraclavicular fossa lymph node - 1 x direct spread (MGG) and 1 x SurePath (Pap)

NG-Set A 6 • Metastatic small cell carcinoma of primary lung origin • Positive for AE1/AE3, synaptophysin, chromogranin, CD56 and TTF-1

NG-Set A 7 • 56 year old male • History of penile cancer. Enlarged left groin lymph node • FNA left groin lymph node - 1 x direct spread (MGG) and 1 x SurePath (Pap)

NG-Set A 7 • Reactive lymph node • No malignant cells seen

NG-Set A 8 • 57 year old female • Thyroid isthmus nodule • FNA thyroid isthmus – 2 x direct spreads (MGG and Pap)

NG-Set A 8 • Colloid nodule showing Hurthle cell metaplasia (Thy 2) • The RCPath system for reporting thyroid cytopathology

NG-Set A 9 • 63 year old female • Abnormal chest x-ray • Bronchial brushing RUL – 1 x SurePath (Pap)

Agar cell block

p40 & CK5/6

TTF-1 & Napsin A

NG-Set A 9 • Lung adenocarcinoma • Positive for TTF-1 and Napsin A; Negative for p40/p63 and CK5/6 • EGFR/ALK/ROS1/PD-L1

NG-Set A 10 • 73 year old female • Lump in parotid gland • FNA left preauricular region – 1 x direct spread (MGG)

Histology

NG-Set A 10 • Acinic cell carcinoma • Milan system for reporting salivary gland cytopathology

Milan system for reporting salivary gland cytopathology

NG-Set A 11 • 60 year old male • Ex-smoker. Abnormal chest x-ray • Bronchial brushing RUL – 1 x SurePath (Pap)

NG-Set A 11 • Non small cell carcinoma, favour adenocarcinoma on morphology • Positive for TTF-1 and Napsin A; Negative for p40/p63 and CK5/6 • EGFR/ALK/ROS1/PD-L1

NG-Set A 12 • 76 year old male • Mass body of pancreas • EUS FNA mass body of pancreas – 1 x direct spread (MGG) and 1 x SurePath (Pap)

NG-Set A 12 • Pancreatic ductal adenocarcinoma

NG-Set A 13 • 77 year old male • Ex-smoker, right effusion under investigation, awaiting CT. Chest x-ray – increased nodular/interstitial changes ?cardiac ?inflammatory ?carcinoma.

• Pleural fluid – 1 x Cytospin (MGG) and 1 x SurePath (Pap)

NG-Set A 13 • No malignant cells seen • Lymphocytic effusion

NG-Set A 14 • 59 year old female • RLL/RML collapse and small effusion. Mucus plugging ++. Bronchoscopy to r/o endobronchial lesion

• Bronchial lavage RLL bronchus – 1 x SurePath (Pap)

NG-Set A 14 • No malignant cells seen.

• Aspergillus ++, eosinophils and Charcot laden crystals • Grocott/PAS + • Microbiological analysis

NG-Set A 15 • 88 year old female • Diffusely enlarged thyroid gland • FNA left thyroid – 1 x direct spread (MGG) and 1 SurePath (Pap)

NG-Set A 15 • Hashimoto’s/chronic lymphocytic thyroiditis (Thy 2) • Correlate with serum anti-thyroid antibodies • The RCPath system for reporting thyroid cytopathology

NG-Set A 16 • 88 year old male • Haematuria • Urine – 1 x SurePath (Pap)

NG-Set A 16 • High grade transitional cell carcinoma/High grade urothelial carcinoma • Paris classification

NG-Set A 17 • 43 year old male • Miliary shadows on chest x-ray • Bronchoalveolar lavage lingula – 1 x ThinPrep (Pap)

NG-Set A 17 • No malignant cells seen

NG-Set A 18 • 13 year old female • Large ovarian mass on CT scan • Peritoneal fluid – 1 x cytospin (MGG) and 1 x ThinPrep (Pap)

NG-Set A 18 • Metastatic germ cell tumour (Dysgerminoma) • Histology (left ovary) – Dysgerminoma – diffusely and strongly positive for PLAP. FIGO stage3c (para-aortic lymph node - metastatic dysgerminoma)

NG-Set A 19 • 34 year old female • Immunocompromised. Bilateral pulmonary infiltrates • Bronchoalveolar lavage – 1 x ThinPrep (Pap)

Grocott

Grocott

NG-Set A 19 • Pneumocystis Jiroveci present • Grocott

NG-Set A 20 • 78 year old male • Stricture common bile duct • Bile duct brushing – 1 x ThinPrep (Pap)

NG-Set A 20 • Metastatic squamous cell carcinoma • Lung primary • Deceased

NG-Set A 21 • 77 year old • RUL scarring. Bronchoscopy to rule out malignancy • Bronchoalveolar lavage – 1 x ThinPrep (Pap)

NG-Set A 21 • No malignant cells seen

NG-Set A 22 • 70 year old male • Dysphagia ?cause • Oesophageal brushing – 1 x ThinPrep (Pap)

NG-Set A 22 • Small cell carcinoma • Corresponding oesophageal biopsy – Malignant endocrine tumour of oesophagus (small cell carcinoma) • Deceased

NG-Set A 23 • 76 year old male • Stricture common bile duct • Bile duct brushing – 1 x ThinPrep (Pap)

NG-Set A 23 • Adenocarcinoma

NG-Set A 24 • 46 year old • Smoker. Haemoptysis. Cavitiating left upper lobe pneumonia. Slow to resolve.

• Bronchial trap – 1 x ThinPrep (Pap)

NG-Set A 24 • Non - small cell carcinoma, NOS • Septated fungal hyphae, morphology c/w Aspergillus also present • Negative for TTF-1, Napsin A, p40/p63 and CK5/6 • EGFR/ALK/ROS1/PD-L1

NG-Set A 25 • 81 year old male • Haematuria • Urine – 1 x ThinPrep (Pap)

NG-Set A 25 • High grade transitional cell/urothelial carcinoma with squamous differentiation • Paris classification

NG-Set A 26 • 52 year old female • Pelvic mass on CT scan • Peritoneal fluid – 1 cytospin (MGG) and 1 ThinPrep (Pap)

NG-Set A 26 • Adenocarcinoma cells showing high-grade cytological atypia present • Positive for Ber-EP4, CK7, PAX-8, WT-1 and HNF1-β; Negative for Calretinin/D2-40 and CK20 • Ovarian primary – Clear cell carcinoma

NG-Set A 27 • 81 year old female • History of pancreatic cancer • Ascitic fluid – 1 cytospin (MGG) and 1 ThinPrep (Pap)

NG-Set A 27 • Spontaneous bacterial peritonitis • No malignant cells seen

NG-Set A 28 • 78 year old female • History of endometrial cancer • Peritoneal fluid – 1 cytospin (MGG) and 1 ThinPrep (Pap)

NG-Set A 28 • No malignant cells seen • Collagen balls present

NG-Set A 29 • 75 year old female • Unilateral pleural effusion ?Cause • Pleural l fluid – 1 cytospin (MGG) and 1 ThinPrep (Pap)

NG-Set A 29 • No malignant cells seen

NG-Set A 30 • 74 year old female • Unilateral pleural effusion ?Cause • Pleural l fluid – 1 cytospin (MGG) and 1 ThinPrep (Pap)

NG-Set A 30 • Metastatic adenocarcinoma • Positive for Ber-EP4, CK7, GATA3, ER, PR and GCDFP-15; Negative for Calretinin/D2-40, CK20 and TTF-1/Napsin A • Breast primary.

NG-Set A 31 • 28 year old male • Enlarged neck nodes ? cause • FNA right level 5 neck node – 2 x direct spreads (MGG)

Agar cell block

Agar cell block

CD45

CD30

CD15

PAX-5

EBV-ISH

NG-Set A 31 • Classical Hodgkin lymphoma • Positive for CD15, CD30, PAX-5 and EBV-ISH; negative for CD45, CD3, and CD20 • Histology: Nodular sclerosis classical Hodgkin lymphoma